Getting It (Part 1)

Today is our second daughter’s first birthday and therefore also the anniversary of The Event.  Writing about what I’m going through today dovetails quite nicely with a topic I had planned to broach this week: the action of time on healing from mental illness.  What I don’t want to do is breed discouragement.  I’ve been sharing things about how to make headway in certain aspects of anxiety, depression and panic, but many of you out there are still very much struggling in the midst of these conditions.  Note: This is the advantage of an actual counseling relationship over reading self-help books/posts.  Readers often get the impression that because they now “know” what to do, they should somehow be “cured.”  Disappointment, shame, guilt sets in when this doesn’t turn out to be the reality.  So here comes reality.

This is what I posted on Facebook this morning:

Happy (actual) 1st birthday Ellie! When I got to see you for the first time after waking up, I thought to myself, “Oh pfttttt. No matter what, this child is worth it.” It’s still true and always will be. Hey, in a way, we share birthdays. Thanks for the “reboot” 🙂

My prayer for you and your sister, little one, is that you would seek and know true wisdom.  First and foremost that you would taste and see how gracious the Lord is.  When you had next to zero chance of ever knowing your mother, He saw you personally and restored her completely to you.  This is your God – it is His very nature.  Your father and I have no desire to raise miniature versions of ourselves.  Be transformed into His likeness and go out in confidence and security. 

These statements are profoundly true and exactly what I want Ellie to know about her birthday.  I’m thankful I post this, and after my firstborn finishes her breakfast, I drive her to preschool, talk to her teachers and then stop at Trader Joe’s for some groceries.  It’s my regular day off from my part time job.  On the way home, I begin to become conscious that I am a jumble of ill-defined thoughts and emotions.  Bummer.  I had hoped to glide through this day gracefully and triumphantly, focusing on my cute baby.  I get home, and as I’m putting away the groceries, I feel very dizzy, like I need to lie down.  The lines of light created by the plantation shutters begin to undulate.  I drink some water.  I begin to watch the clock.  Strange.  Without me having consciously marked it, I was induced right about now last year.  I suddenly feel an irrational dread that the same sensations I felt last year will come over me again.  I start wondering how I’m going to get through the day.  I want to cry, crawl into bed and pull the comforter over myself.  Well, today is going to take a little extra work.  Switch to manual controls.

The first thing I do is whisper thanksgiving to God.  Thank You that it is the joyous occasion of Ellie’s birthday.  Thank You that it has been one year, during which time I watched my children grow, helped build a foundation for them, kissed and conversed with my husband, saw friends and family.  Thank You that I am so healthy.  I’ve been able to go to work.  I’m not restricted from any activities.  I have no long term fallout with which to concern myself from the event.  Praise You for this utterly miraculous work, but more so because I know this is who You ARE.  That, Father, is the truly comforting part.  Please help me through today.

I resist getting into bed, lying on the couch.  Rumination tends to set in when we do that (lie still, doing nothing), and we all know that rumination is mostly negative in nature and only serves to intensify our suffering.  Plus, I don’t want to be in the same physical position as I was in when the hemorrhage started.  That would only give my body more of an opportunity to engage its muscle memory and make me suffer.

Thankfully, one of my best friends stops by this morning with her son, and we talk about parenting and life happenings in general for an hour or so while he plays.   This is a real blessing.  I’m distracted from the memory and fear of my heart racing.  I’m comfortable that she will understand if I act a little strange or even if I have a full blown panic attack right in front of her.  If she hadn’t come over, I probably would have called her today.

After my friend and her son go home for nap time, I call my mother-in-law and chat with her about the kids.  Ellie, my birthday girl, slept over there last night, because frankly, she wore me out after a 12-hr day yesterday. She’ll be home later on today, so we can celebrate together.  I sit down and take care of some items on my To Do List.  Still, I find myself watching the clock.  How will I feel the minute she was born?  How will I feel at the time when they took me into the OR (thankfully, I don’t know exactly what time that was – ignorance really is bliss sometimes)?  I still want to cry and crawl under the bed.  I allow myself the tears but avoid the bed like the plague.

Distraction is a fine and useful tool, and indeed, some people employ it their entire lives to keep from having to face the difficult feelings.  It is also exhausting to maintain and does not represent true healing.  It moves you neither forward nor backward in growth and maturity.  Good or bad (probably a little of both), I’m not built to be able to distract myself from the real issues indefinitely.  I decide at this point to have a talk with myself.

1.  June 18th holds both utterly joyous and utterly awful moments for you.  Do not allow in shame and guilt because you feel unable to feel unequivocally happy today.

2.  This is the first anniversary of the event.   Be hopeful that time will mute and heal some of the more bothersome emotions.

3.  Today, of all days, you can probably safely chalk up any physical symptoms to post traumatic stress.  First off, there is no rational reason to be anxious.  Remember the facts; cling to reality.  You are not pregnant.  You are not newly postpartum.  You are not losing blood.   You can’t self-induce a code blue.  Ok, so your heart races a little, and it feels like your BP is crashing.  Well, obviously PTSD.  You feel short of breath, dizzy, unable to focus?  PTSD.  No need to let anticipatory anxiety of emotions and physical feelings suddenly “getting you” take over.  You’ve done the things that you need to do for a while to tamp down the fire.  You have a BP cuff at home.  You have your husband’s pulse oximeter.  Yes, these items are neurotic for the average 30 yr old but not pathological (you haven’t transformed your house into a medical clinic; you haven’t demanded monthly labwork to tell you that you’re still alive etc.).  It’s ok to accept grace where grace happens without feeling the need to “power though” all the time.

4.  Should the feelings of panic crop up, which will probably closely mimic the low blood volume you experienced, you know what to do.  See Agoraphobia Pt. 2.  Courage is not always about “toughing it out in the moment.”  More often, it happens as the result diligence, preparedness, knowledge and wisdom.

Just as I am dialoguing with myself about these things, my dear wonderful husband calls from the hospital.  He knew this was going to be a hard day for me, even though I hadn’t said anything about it.  The ICU is slow right now, and the residents are taking turns going home early.  He told them that it was his daughter’s birthday today, so it’s his turn.  He’s coming home to face the day together!  In my wildest dreams, I had not expected him to be able to do this for me today, being a medical resident during a very busy year.  “And though a man might prevail against one who is alone, two will withstand him—a threefold cord is not quickly broken.” Eccl. 4:12.  It is just further evidence that the Lord sees us and loves us each intimately.

How do I feel now?  Better.  I’ve given my feelings a place to exist, so they don’t tantrum like an out-of-control child, but they have not been granted full access to hijack the entire day.  It’s not that it would be “bad or wrong” to spend today in bed, crying and confused.  I just don’t want to.  I have better things to do and want to spend the day with my family.

So there you go.  I’m with you!  Days will be hard – one of God’s less often mentioned promises 🙂  An entire year can bring back the sensations I felt on June 18, 2011.  But we will endure with help and, in the end, we shall be called overcomers together.

Just a quick note about the previous post, Agoraphobia Pt.2:  I did not directly address the topic of predisposition to panic attacks, whether nature or nurture.  Both are well-established and often observed, but the focus of the post was to build tools toward facing the attacks.  Knowing that one is predisposed thanks to mom or dad’s side of the family doesn’t do much in that regard (except for maybe help to alleviate some guilt and shame).

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Agoraphobia Pt. 2

Alright, work week finished, children taken to wherever they need to go, bills paid, house generally (very generally) put in order.  Time to write! 

In short, the answer to getting over agoraphobia is to stop being afraid of having panic attacks.  Let’s try and make some headway at doing that.

The current thinking on panic attacks is that they act somewhat like icebergs.  The iceberg breaks the surface at some random point in the water in the form of a panic attack, but there are parts of the disorder hidden thousands of feet below the surface and sometimes thousands of feet away from the revealed tip.  So let’s navigate the iceberg (caveat: I don’t know anything substantive about icebergs, so this is as far as the analogy goes).

The Base:  We all have basic beliefs which we rarely bring to the forefront of our minds, about ourselves and the world around us.  For whatever reason, including inadequate attachments during childhood, abuse, trauma later in life etc., people with panic disorder often lack a certain level of “basic trust” in life and the world.  These are basic beliefs like, “I am safe.  I am loved.  I am never alone.”  What is the Christian answer to this problem?

Well, it is knowing that God is with us and for us, that He will never leave us nor forsake us…that He so loved the world that Christ came…that He is the lover of our souls…that no amount of worry in the world can add a single hour to our lives. 

Sometimes this isn’t the problem.  Sometimes the problem, especially amongst Christian women is, “It’s not okay to feel any other way than full and joyful.” “It’s not okay to reveal to anyone anywhere that I have weaknesses.” “It’s not ok to embarrass myself.” “It’s not okay for me to be less than perfect.”

In this case, it is important to remember that is is OK.  It really is OK…because of Christ. We are not what our church culture wants us to be.  We are what Christ says we are: children of God, helpless but for grace and yet instruments in the hands of a mighty God.  Hey, panic attacks are a good reminder of this, aren’t they?

There are two very important distortions which can come to play here.  First, some may believe that I am implying that spiritual exercise, Christianity, is a “mental health tool.” That is, spiritual exercise is a nice “technique” to employ when facing a larger issue of mental health; it’s a nice enhancement to life.  This is false.  Christ saves our souls- this truth is paramount.  Being fully His must be the predominant framework through which we live and face all of life and death.  Just because I am putting forth certain theological principles and verses for the aid of the mentally ill and advising against over-spiritualizing certain matters, does not mean that we do not owe God all of our heart, mind, strength and soul.

The opposite tendency, however, is for some to use the section above and say, “See? I told you that this was a spiritual problem.  All you need to do is [fill in the spiritual blank].”  Indeed, the sufferer might find herself thinking, “Why don’t I have any faith?  I’m a terrible, useless Christian.  I am weak.”  But see how this drives away from God rather than guides to Him?  The reality, the truth, is that we are all imparted with strengths and weaknesses.  Sometimes, our greatest strengths are our greatest weaknesses (ask Martha, Mary’s sister).  So in addition to deciding to show love toward rather than hatred for one another’s weaknesses, let us also to decide to show grace to ourselves in accordance with the Grace that has actually been poured forth.

How does knowing about “the Base” help?  Well, I know that I was raised in a non-Christian home and did not feed at the fount of truth and grace every day.  I know that I was separated from my mother during an attachment phase in my childhood.  I understand that I, because of my sin nature, see through warped lens and unclean eyes, which include tendencies toward perfectionism.  Therefore, I am aware that my automatic beliefs will tempt me toward despair or anxiety.  Thus, I must make sure to fortify the base daily with remembrances of God’s reality and prayer.

Caveat:  We all, panic sufferers or not, need to mind the Base, but do look at your medication list and get a physical if you start having panic attacks.  Rule out side effects, thyroid issues and other physical etiology.

The Middle: In addition to automatic thoughts, there are stressors.  There are events, traumas, to do lists, expectations, disappointments, relational difficulties, transitions and on ad nauseum with which to contend.  Our culture, the result of our fallen desire to build towers unto the skies, cajoles us into sprinting through life.  We’re all racing, racing all the time.  At a certain point, this middle layer of the iceberg will mound tall enough to break the surface.

In stress management books and courses, there is often an inventory of life events and activities which the student is asked to complete.  The idea behind this is to be mindful of what is beginning to pile up on our proverbial plates.  We can’t control everything that happens to us, but we are to act as faithful stewards with what we can control.  Fifty handmade cupcake toppers on top of a full-time job, four kids with activities and the charge of a huge house?  Relaxing or stressful (only you can answer that question)?  Two church events, three birthday parties and a barbeque in one weekend?  Being a good friend/church member or absurd (again, this differs from person to person)?

There is no way to avoid stress altogether in life, and in fact, we are created for short outbursts of stress (it keeps us healthy).  Chronic stress, a constant state of “just making it,” however, can lead to stress-related illnesses, such as panic disorder and agoraphobia.  A habit that helps me has been questioning myself about my motives for taking on what I do.  Deciding on pursuits where my motives are pure and, as far as I can tell, God-honoring cuts out at least 75% of the demands on my psyche! 🙂

The Tip: 

Believe me, I empathize with you that panic attacks feel scary, but I promise, we are not helpless!  God has built the fight or flight response into us to protect us, but He has also given us, as He always does, a way out – a way to stand up.   What to do if a panic attack crops up:

Your heart is racing out of your chest/throat:  Try swallowing something.  Eating triggers the parasympathetic nervous system, our relaxation mechanism.  Sipping hot tea as slowly as you can also help, because it combines swallowing with slowing your breathing down.  Another technique is to engage the “dive reflex” — splash cold water on your face and press on your closed eyelids.  If your heart is skipping around, don’t worry.  Adrenaline dumping into your bloodstream will have that effect on your heart, but, in this context, it’s not a cardiac event originating for your heart.  Coughing forcefully will often stop them.

You are gasping for air:  This is hyperventilation.  You have to be counterintuitive about this, because you are actually taking in too much oxygen.  The imbalance in O2 vs. CO2 in your system is making it difficult for your body to efficiently process the O2.  Slow down your breathing in the following ways (it feels hard).  Breathe into a bag or the sleeve of your shirt to rebreathe CO2, or cup your hands over your mouth and nose.  Alternatively, close one nostril from the outside with your finger, so you’re cutting your O2 intake by half.  Breathe as slowly as your can.

Your throat feels like it’s going to close up:  It’s not going to close up.  If you can talk, it’s not closing up.  What helps me with this very uncomfortable sensation is carrying around a little hard candy.  Sucking on a piece of hard candy helps me relax all those little muscles in the throat, so they start to release me from the death grip.

Derealization:  This is the fishbowl vision, feeling hopelessly detached to what’s going on etc.  Ground yourself.  Say out loud what day of the week it is, the date, the time.  Say where you are, what you’re doing.  Feel the texture of things around you – the arms of a chair, the surface of a table, the steering wheel etc.  A good way to overcome this is to talk to someone!  People have an amazing grounding effect on one another.  Making eye contact and exchanging dialogue has helped me through many a panic attack.  This is difficult, because your basic instincts are telling you to run and hide.  It’s sometimes like trying to steer and 18-wheeler in a cul-de-sac, but stick with it, and it works.

Need to run:  It helps sometimes to walk around slowly outside and free yourself from the mental/physical vise of a panic attack, but there’s no need to leave the event, activity or situation.  It’s just like being out in the water.  Ride the waves up and down, up and down, knowing that they’ll eventually settle down completely (10-20 minutes with perhaps some shakiness afterward).  It takes time and practice to believe this.

Feeling shaky, weak, nauseous:  You can get through anything during a panic attack.  You can drive, you can care for your children.  You don’t have to worry that you’ll be helplessly flailing around in the middle of nowhere.  Remember that this is the body’s fight or flight response.  This is that mechanism by which mothers lift cars to save their children.  Whatever you need to do, you’ll get through it.  Having said that, it does feel awfully bad when you’re not actually running from a tiger, so if you can, find a quite place and comfort yourself (first, learn to comfort yourself).  The more Scripture you’ve memorized, the better.  Your mind will be biologically predisposed during the attack toward ONLY negative thoughts, because it is threat assessing to protect you, so you need to start whisper calming, soulful, true things into it.  It will calm.

Hope this helps!  Feel free to pass this onto anyone you know who might be struggling.  It’s a process, so reading this post won’t cure anyone, but practicing some of these things can help make panic attacks less frightening and bewildering.  In turn, having some tools to use against panic attacks can make the outside world less threatening, alleviating agoraphobia.

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Agoraphobia Pt.1

Quick note:  I plan to move the two posts per week to Mondays and Fridays.  That way, they’re a little more spread out, and it also works better with my schedule.

What about people with agoraphobia?  I asked myself after I wrote Going to Church.  You can’t just stick everyone in a basket, tell them to go to church and not say anything more about it.  I will say a bit more about agoraphobia, a topic with which I’m intimately familiar.

After my thyroid ablation procedure, I started feeling intensely “on edge,” which is strange because you’re supposed to feel irritable and emotionally labile if your thyroid is too high.  For whatever reason, I developed a level of anxiety I’d never known before.  Hyperthyroid, I was euphoric with unlimited energy.  Hypothyroid, I am undone.  At first, it was just panic attacks – a sudden rush of adrenaline and the sense of impending doom.  The heart, one’s thoughts, one’s surroundings begin racing out of control.  It’s incredibly difficult to breathe.  Sometimes, there’s chest pain.  Other times, your throat feels like it’s closing up.  Sometimes, your heart is both racing and skipping.  You are certain that this is either the end of your life, your mind or the end of the world.  You just want to stop and assess the situation for a moment, but you can’t.  You’re dizzy; your mind is absolutely screaming to get out of whatever situation you are in.  You can’t focus.  You feel trapped in a personal hell and unable to get out, hopelessly detached from what’s going on around you.  You body temperature is by turns climbing out of control or you are shivering.  Your limbs are tingling and numb.  Sometimes, you want to throw up.  It is the worst experience you have ever had in your life.

And it keeps happening.  Nothing in particular seemed to trigger these episodes.  I could be sitting in a meeting at work.  I could be driving in the car.  I could be watching TV with my husband.  Once, I was sitting in the middle seat on an airplane.  The problem was that I didn’t know how to stop them.  I didn’t know how long they’d last, and it certainly felt like they lasted forever.  When an attack did end, I didn’t know how or why it ended and was left bewildered, wondering when and where the next one would strike.  Once, I went to urgent care, because I thought I was having an asthma attack – adult onset asthma or something.  Another time, I thought I was having anaphylactic reaction to something I ate, because my throat felt like it was closing up.  Many more times, I was convinced I had some kind of heart disease, because the my heart would be racing and skipping all at the same time.  Whenever my doctors would do the labs, have me go through the echos, the stress tests, the Holters etc., and tell me that they found nothing, I would sit there uncomprehending.  Nothing is not the word to describe it.  Absolute chaos and helplessness sums it up pretty well, though.

Being the quick study that I am, I soon found myself wondering, what happens if one of these strikes when I’m far from home?  How will I get home?  What if I’m on a plane, and there’s nowhere to run and get some fresh air?  What if I’m in a meeting with an important client?  What am I going to do – just run out of the conference room?  I found myself starting to instinctively avoid a myriad of situations.  First, it was situations where finding comfort during a panic attack would be difficult – downtown LA by myself, airplanes, large professional gatherings in the evenings etc. Then, it was situations in which escape would be difficult – crowded restaurants, large theme parks or buildings, places that were too far from freeways and had to be reached after too many traffic lights.  The problem wasn’t just that I found these places threatening.  It was also that I had lost any desire to participate in the associated activities altogether.  Like a bright flash, the intensity of the panic attacks had blinded me and bleached out every other experience in life.  Soon, I was shaky walking across the street to the grocery store.  Check out lines, being away from my car, being without a means of escape, terrified me.  I wanted my husband nearby whenever possible.  I felt very alone.

Before long, I felt incapable of going anywhere, literally terrified of leaving the familiarity of home.   I think that mass media often presents an unhelpful picture of agoraphobia.  I remember watching a Law & Order episode in which an agoraphobic girl’s confinement to her house was almost portrayed as a lifestyle choice.  The truth is, agoraphobics are not exactly happy at home.  Home represents a tiny prison with unseen bars; you hate it, but it’s the only place you feel you can be.  I would say “safely be,” but it doesn’t always feel safe there either, because the panic attacks come from within you.  It’s just safer, so that should you have a panic attack, you’re free to curl into a ball under the bed, or sit crying in the bathroom.  It’s a tiny bit of control in a situation that seems to be reeling out of control.  You’re fully aware that agoraphobia has consumed the carefree life you once knew.  No more impromptu weekend flights to visit friends.  No more hikes deep into Yosemite.  Places in general no longer feel safe, and since everywhere is a place, you feel you have no place anywhere on earth.  Depression can then pounce unmercifully like a carnivorous cat, as if to finish you off altogether.

HOWEVER, another way in which popular culture has distorted our understanding of agoraphobia is to present it as some kind of semi-permanent state, a way of living that befalls a tiny percentage of unfortunate souls.  This couldn’t be further from the truth.  Agoraphobia is highly responsive to treatment and can be a very short-lived situation.  I would no longer classify myself as agoraphobic, although certain situations still present more of a challenge than they used to (when I didn’t have to think twice about much of anything).  I was so shocked by this sudden and seemingly catastrophic turn of events that it took me a long time to learn the things I’m going to share in Part 2 of this post.  Thankfully, by Grace, I did not give up a decade or even five years of my life to agoraphobia, but I wish I had been as quick of a study when it came to recovery as I was of the ways of anxiety.

For those in the midst of such suffering, I won’t leave you hanging here.  Here are two first line offenses against agoraphobia:

1.  Don’t get sad; get mad.  Fear begets fear, so don’t stay under the bed.  You need to picture yourself facing the intense anxiety nose to nose.  Say to it that it is not taking your life away.  Behave as if it is not a factor – For example, “I don’t want to go to the concert, because we might be stuck in traffic.  If I have a panic attack, there is nowhere to run.”  Decide to go to the concert anyway.  (We’ll talk about the practical points of how to get yourself to the concert next time).

My mom told me that she struggled with a brief bout of agoraphobia in her early twenties.  She had intense health anxiety for several years and was convinced that she was dying of some condition which the doctors had not been able to detect.  As a result, she refrained from physical activity.  She lost the desire to go anywhere.  She kept her relationships shallow.  One day, she became so infuriated with how absolutely dismal her life had become, she pulled out all of her family’s and extended family’s quilts and comforters and spent an entire day washing them all -by hand.  In essence, she told anxiety to shut it.  It’s just a paper tiger that looks very real.  That was the end of her agoraphobia.

2.  Don’t be afraid of benzodiazepines.  Want to avoid developing agoraphobia?  Accept your doctor’s prescription for Xanax or Ativan or whatever benzodiazepine as soon as it’s determined that you suffered a panic attack.  Benzodiazepines begin working immediately to lessen the intensity and duration of panic attacks, so that your mind doesn’t get quite so traumatized and learn instinctive avoidance via the fight or flight response.  Whether it seems like it or not, our minds are prodigies at self-protection.  If it believes that your equilibrium is being compromised, it will do anything to protect you.  About one third of panic attack sufferers will develop agoraphobia.  There are many factors which have to do with frequency, intensity, duration of the panic attacks, as well as cognitive pathways and genetic predisposition.

Christians often think absurdly about medication.  Doesn’t it reflect a lack of faith in God?  Well, if that’s the case, then let’s just all stop receiving medical intervention altogether.  Is it a slippery slope into addiction?  1.  It’s pretty hard for anxious people to get addicted to anything.  They’re almost opposite personality tendencies. We’re such control freaks that we won’t let ourselves even approach the threshold of the antechamber to going there.  2. Your doctor will most likely not need to give you refills indefinitely.

Can I solve this on my own?  Maybe, maybe not.  How much of life would you like to miss?  Within the thought, I should overcome this on my own, is often a heavy degree of guilt and shame.  I did this to myself, so I need to undo it.  That is often a lie.  I’m not saying that with a Xanax, you don’t have to do the hard work of putting out the fire.  The Xanax just helps control the fire, so it doesn’t become an out-of-control forest fire requiring even more resources and leaving more destruction in its path.

Until Friday then!

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Going to Church

Today, we’ll say a few words about another difficult topic for those experiencing mental illness: church attendance.  I’ll make my position on this clear from the outset.  I believe life together is an inherent part of calling oneself a Christian.  I do not believe that Christians struggling with their mental health have a pass when it comes to “not giving up meeting together” (Heb.10:25).

However, it is important to acknowledge several aspects of being a literal part of a literal Body.  It’s not always pleasant.  I will be hurt from time to time.  Worship is not always an easy task.  Loving one another is part of worship and may prove the hardest task of all, especially when feeling vulnerable.  There is no perfect church.

Really accepting these facts goes a long way toward countering the inertia of showing up at church, but if I’m perfectly honest, the thought, “Man, when I’m REALLY going through something difficult, the church is essentially useless” has crossed my mind more than once.  So let’s do a little cognitive therapy on that thought.

The thought itself, depending on how fully I believe it, makes me reluctant to pull myself together and practice enough personal hygiene to go to church.  The longer I excuse myself from going on the basis of mental health, the more difficult it will be to go back.  The longer I don’t go back, the worse off I am in my mental health.  Remember, a spiritual community has been well established as a positive for mental health.  Along with mental health, absence from the church drags on my spiritual core.  Disciplines like studying Scripture deteriorate. I begin to avoid prayer because I know what God is going to tell me.  And the outward expressions this inner environment make me feel ashamed.   In the end, it becomes a vicious downward spiral.

The evidence FOR the thought, “Man, when I’m REALLY going through something difficult, the church is essentially useless.”

1.  It’s not an authentic place.  Made-up women with matchy-match children smiling their spiritual smiles and nodding their spiritual nods.  Pastries and coffee, laughter and pats on the back.  This is an escape from life at large for them, but life at large won’t leave me alone.  Who do I approach to bear my wounded soul?  Why do they keep smiling and walking by?  Who will help me break out of this terrible prison?

2.  The male and female leaders don’t understand.  They may never have heard such a problem expressed.  They have no resources.  They don’t answer the truly difficult questions.  They are difficult to reach and slow to respond.  When you do get in for an appointment, they say a prayer for you and send you on your way.

3.  I can’t focus on the sermons because my brain is so full of noise, and I don’t know how to shut it off.  The statements and songs I catch don’t seem to pertain to me.  I feel trapped in an odious glass bubble and can’t break out.  The fluorescent lighting, the crowds and the too loud sound amplifier threaten to blow me over.

4.  Every time I go, I just want to run away and go somewhere that’s more accepting of the reality of my situation.

The evidence AGAINST the thought: “Man, when I’m REALLY going through something difficult, the church is essentially useless.”

1.  Through the church, I have built longstanding relationships with people among whom I can share my burdens.  It may not happen during the coffee hour after service, but I’m comfortable that I can approach them any time and share.  These may be individual friends or a Bible study or an Agape group.

2.   The pastors and leaders may not be able to help in a practical sense, but it is comforting to know that their hearts are “for me” – that they have pastoral hearts of care and non-judgement.  I can be open and contribute to the institutional resources of the church by supplying contacts and links, by advocating for greater supportive care for those suffering like me.  Sometimes, contributing is part of healing.

3.  Hearing the Word preached is important but not the entire point of going to church.  In order to hear the sermon, I can try to attend the smallest service – perhaps on a Wednesday or Saturday evening.  I can also just hang out in the courtyard, grab a friend and talk/pray somewhere, volunteer to serve with the babies or kids, have a cup of tea.  I can show up and be amongst the assembly at church and that, in itself, is a win.  By faith, I can trust that God Himself supplies the people, words, comfort, love I might need at any given time, as I continue to walk.

4.  There is no perfect Church, but by being authentic myself and being part of the Body, I influence my own environment.

More balanced thought: “I acknowledge that going to church will not be a perfect situation. It is partly me, as my perceptions are skewed, and partly the culture of church.  However, I understand that it is an act of faith and obedience to go.  I also know that there are many potential benefits to me being there.  So I will not preemptively judge the experience but rather make a commitment to show up and do my part whenever possible.”  I say whenever possible, because (another theme of this blog), nothing in life is black and white, and obviously, it’s not about legalistic conformance to my own standards, but about the posture and growth of my soul.  If you make it to church, it’s a win.  If you don’t make it, take steps toward the next opportunity.

This is not to say that the church can’t grow in actually helping those experiencing mental illness be at church.  For example, what if you’re new and struggling?  See A Vision for the Church Part 1 & Part 2.  One of the main objectives of this blog is to influence fundamental change in many churches’ treatment of mental illness and to rally for supportive care.  Here again, notice that we can’t engage in such a dialogue unless we are actually…well, engaged.

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Talking to God

I had planned to write a post about prayer today, and coincidentally, also came to Luke 8 in my Bible reading program.  The storm at sea, the Gerasene demoniac, the hemorrhaging woman and Jairus.  Accounts so vivid and so personal.  I wanted to jot down some things I’ve learned about talking to God in the midst of mental illness.  His grace toward the inhabitants of Luke 8 will light the way.

The Storm.  Prayer can certainly be a problem in the midst of psychic suffering, even though we’re well aware that it’s commanded of us to pray without ceasing, that it’s good for us and that it can very well be protective of us during a time of psychic distress.  On a deeper level, we understand that we are designed for spiritual communion with God just as we are designed to breathe.  Being bombarded by intense feelings, however, can threaten our spiritual senses, and, somehow, the our direct line to God seems severed.  Like the disciples in the boat, it certainly looks and feels as if God is asleep; He doesn’t care; maybe He’s planned it this way; I’m in this monumental battle alone.  For those who have never suffered a mental illness, these emotions can certainly be intense – I’ve never been in a sinking ship, but I can say for certain that it can feel like a relentless hemorrhage.

Expectations and Reality.  Prayer happens in the midst of life’s drama, not in spite of it.  That is, there is more than one way to pray.  The Christian marketing image of a clean cut guy or gal, head bowed in a serene wood, hands enfolding a Bible, everything backlit with the halcyon glow of sunrise is one possible experience.  Another is the sheer panic of “Master, Master, we are perishing!” Look, Jesus asked them where their faith was after the fact, and some people claim that Job was rebuked at the end of his tale.  I’m no better creature than they were.  I’m not going to assert that I would have transcendent peace in a sinking ship or having lost ten children.  God heard and showed up, didn’t He?  That’s enough for me.

Other times, we muster all of our energy to demonstrate just one act of faith in God, like the hemorrhaging woman.  Too afraid and desperate to even speak, she expended what energy she had left in a communication of faith, and that was enough for God.  Yet another posture of prayer: The ESV says Jairus fell and “implored” Jesus because the circumstances seemed to dire- that’s a familiar one.  The demoniac’s own circumstances – the seizures, the shackles, the exposure – cried out for God’s help, the sufferer quite unconscious of it.  The point is, just because I don’t feel like I can pray perfectly…just because God seems otherwise preoccupied and not with me…just because I may feel too unclean to do it, doesn’t mean that I shouldn’t reach out and communicate with God.  The open line of communication is key to healing, and there is more than one posture of prayer.

Practicing the Presence of God.  This sounds too childish to admit, but sometimes I pretend that Jesus is my imaginary friend.  That is, when I need comfort, I imagine Him sitting on a chair next to my bed.  When I need healing, I imagine Him laying hands on me.  I recently read an article about people who spend their lives in prayer (I forget where) and was surprised to find that that’s how they all began – by magical thinking, by using their spiritual vision.  Embodying God in this way really helps me keep talking to Him.  It roots out seeds of bitterness toward Him, which seem to spring up so quickly during times of emotional distress.  Once I’ve expressed my feelings, the field is open for discussion, teaching and peace.  True confession.

It’s OK to be silent.  Just show up and sit there.  In front of Him.  Waiting; expecting.  “For God alone my soul waits in silence; from Him comes my salvation.”  Job did it.  For all those healed and transformed by the Lord in Scripture, it is the silent waiting between the asking and the miracle where the real spiritual work takes place.

Commiserate with the Psalmists. My favorite Psalms for times of distress: like half of them! OK, like Psalm 6, 22, 31, 38, 42-45, 51, 61, 62, 69, 86,88, 102,109,130,137, 142, 143, 144.  But also, do as the psalmists did.  Look to the future in the light of God (I will sing You a new song).  Look to the past in the light of God (force yourself to list all the provision He’s already supplied).  This is especially therapeutic in the case of depression and anxiety, because everything will look bleak up until the moment that it’s not.  So doing as the psalmists did is a form of cognitive restructuring – aligning oneself more closely with reality, the truth.  Also, don’t ignore the psalms about being falsely accused.  Mental illness falsely accuses.  Glean comfort that you will be vindicated.

One of my favorite prayers.  Believe it or not, it comes from the first section of The Power of a Praying Wife:  “I am not able to rise above who I am at this moment.  Only You can transform me.”

Believing is good enough.  We want to get back to normal and feel the surge of joy at a “Hallelujah” or an inner bulwark of strength upon declaring “The Lord is my fortress, an ever present help in trouble.”  It’s frustrating and painful.  We feel like a fake Christian.  But the battle is not won on the level of emotions.  Otherwise, everyone in Luke 8 would have been lost.  He commands us not to feel but “only believe” (Lk. 8:50). What did Jairus feel?  Probably overwhelming terror and grief over the death of his only child.  But he held onto belief and went through the motions based on that belief.  The result was resurrection.

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My last post was kind of random, but at least I wrote something on the day I was supposed to write something.  That’s a (small) win.  Maybe inspiration and a writing schedule will align at some point in the future.  Thanks for bearing with me.  I could hear some minds in the midst of psychic suffering respond, “You know, if I weren’t in so much excruciating pain right now, I might have been encouraged by what you wrote, about experiencing God and learning the important things in life.  But to be honest, I just feel like I’m in survival mode, and I’ve been asking God for relief but He’s not doing anything!”

I thought I’d use this space to address the issue of waiting on God.  Yes, this blog is about building empathy and understanding, comforting those who suffer with the fact that they are not alone and educating the rest of Christ’s Body as to the experience of the mental illness.  However, most of us, when in distress, are looking also for relief, and as quickly as possible.  And the Body also needs to be equipped with appropriate and effective ways to offer relief.  In short, the blog is about reframing: reframing the Christian community’s views regarding mental health issues but also, in His light and truth, working together to reframe some of our own suffering.  So let’s discuss waiting as it relates to psychic suffering…

One of the reasons I particularly like Christians who struggle with mental illness is because  they’re usually some of the more honest of the bunch.  They’re able to say to themselves and sometimes others, hey, this life is hard.  Sometimes it downright sucks.  I’m not looking for an answer from ameliorating the political realm or improving the environment, or even improving my own circumstances, though those may be worthy causes.  I’m looking for an answer from God Himself, and this is why my suffering touches my soul.  Where is He in the midst of this ridiculous mess?  What are You doing God?  Many of us understand C.S. Lewis when he wrote, “We’re not necessarily doubting that God will do the best for us; we are wondering how painful the best will turn out to be.”  It is not the sovereignty of God in question.  Like all children in pain, we seek comfort from our Abba Father.

I thought I’d enlist some great thinkers and people who have known suffering to help us begin to reframe those painful times of waiting.  Remember, I’m trying to alleviate our suffering by banding us together, by campaigning for the supportive care we truly need but also by doing some cognitive therapy in reframing some aspects of our conditions. So try not to roll your mental eyes at me or these quotes.  Thanks 🙂

See your suffering as a slow dance with God.  Let Him lead.

Timing is so important! If you are going to be successful in dance, you  must be able to respond to rhythm and timing. It’s the same in the Spirit.  People who don’t understand God’s timing can become spiritually spastic, trying  to make the right things happen at the wrong time. – T. D.  Jakes

See that God has more than relief in mind.  Patience is one of those great spiritual disciplines which doesn’t always feel serene on the surface, but can yield unshakable peace underneath.

If any are inclined to despond, because they do not have such patience,  let them be of good courage. It is in the course of our feeble and very  imperfect waiting that God Himself, by His hidden power, strengthens us and  works out in us the patience of the great saints, the patience of Christ Himself. – Andrew Murray

Look beyond the suffering to the light of day – even if that light is His voice saying that we have endured, we have fought the good fight, we are overcomers, we have been good and faithful servants.

If the Lord Jehovah makes us wait, let us do so with our whole hearts; for blessed are all they that wait for Him. He is worth waiting for. The waiting  itself is beneficial to us: it tries faith, exercises patience, trains submission, and endears the blessing when it comes. The Lord’s people have always been a waiting people. – Charles Spurgeon

In the long waiting, God can prove to us our strength in Him.

There are some prayers that are followed by a Divine silence because we are not yet ripe for all we have asked; there are others which are so followed because we are ripe for more. We do not always know the full strength of our own capacity; we have to be prepared for receiving greater blessings than we have ever dreamed of.
–George Matheson

What feels like fear and despair now is really training in courage for battle.

With regard to patience the Lord says, ‘You will gain possession of your souls through your patient endurance’ (Luke 21:19). He did not say ‘through your fasting’ or ‘through your vigils’. I refer to the patience bestowed by God, which is the queen of virtues, the foundation of courageous actions. It is patience that is peace amid strife, serenity amid distress, and a steadfast base for those who acquire it. Once you have attained it with the help of Christ Jesus, no swords and spears, no attacking armies, not even the ranks of demons, the dark phalanx of hostile powers, will be able to do you any harm.
–Gregory of Sinai

God’s way of answering a Christian’s prayer for more patience, experience, hope and love often is to put him into the furnace of affliction. –Richard Cecil

Yes, our suffering runs counter to the ways of the world.  We want to Function! Go get ’em! Produce!  Just Do It!  God’s desires may be just the opposite for us, for a season.  Align ourselves with His desires and have a greater degree of peace.

There are seasons when to be still demands immeasurably higher strength than to act. Composure is often the highest result of power. To the vilest and most deadly charges Jesus responded with deep, unbroken silence, such as excited the wonder of the judge and the spectators. To the grossest insults, the most violent ill-treatment and mockery that might well bring indignation into the feeblest heart, He responded with voiceless complacent calmness. Those who are unjustly accused, and causelessly ill-treated, know what tremendous strength is necessary to keep silence to God.
–Margaret Bottome

To wait open-endedly is an enormously radical attitude toward life. So is to trust that something will happen to us that is far beyond our imaginings. So, too, is giving up control over our future and letting God define our life, trusting that God moulds us according to God’s love and not according to our fear. The spiritual life is a life in which we wait, actively present to the moment, trusting that new things will happen to us, new things that are far beyond our own imagination, fantasy, or prediction. That, indeed, is a very radical stance toward life in a world preoccupied with control.
–Henri J. M. Nouwen

God has not abandoned us in His silence.  It is just the opposite.

Never think that God’s delays are God’s denials. Hold on; hold fast; hold out. Patience is genius. –George-Louis Leclerc de Buffon

“The beauty of the world is the mouth of a labyrinth. The unwary individual who on entering takes a few steps is soon unable to find the opening. Worn out, with nothing to eat or drink, in the dark, separated from his dear ones, and from everything he loves and is accustomed to, he walks on without knowing anything or hoping anything, incapable even of discovering whether he is really going forward or merly turning round on the same spot. But this affliction is as nothing compared with the danger threatening him. For if he does not lose courage, if he goes on walking, it is absolutely certain that he will finally arrive at the center of the labyrinth. And there God is waiting to eat him. Later he will go out again, but he will be changed, he will have become different, after being eaten and digested by God. Afterward he will stay near the entrance so that he can gently push all those who come near into the opening.”  ― Simone Weil

I’ll end this post on a totally practical note.  I learned this visualization while trying to master some relaxation tape or another.   When I recognize that I need patience, I imagine patience filling a giant tureen.  I take the handles and pour it all over myself, allowing it to wash over and seep into me.  It’s worked quite a few times, even during unmedicated childbirth, which I’ve already mentioned that I prefer to depression.  I hope some of the words above acted as balm to your soul.

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Facing the Facts

In recent days, a string of disquieting thoughts have paraded themselves into my consciousness, asking me why in the world I am so neurotic.  Can’t you go one day without wondering whether a panic attack will happen here or there, now or later?  Why can’t you ignore the normal metabolic ups and downs of each day without over-analyzing?  I really should practice thought-stopping more often.

Of course, I didn’t, and upon engaging them, I came to the realization that I’ve faced death exactly three times in the past eight years.  In 2004, I was diagnosed with Grave’s Disease from routine bloodwork.  The endocrinologist’s exact words during my first consultation with him were, “You need to take this seriously.  I’ve had patients die with levels like yours.”  Then, we spent the next half an hour trying to decide if my ensuing reaction was a sudden panic attack or an actual thyroid storm – possibly fatal.  In 2008, my pregnancy with our first child led to a sudden case of myxedema psychosis, which I suppose is better than myxedema coma, except for the fact that it took every ounce of faith and self-control I had not to do anything foolish – possibly fatal.  In 2011, I safely delivered our second child, but ended up with a postpartum probable amniotic fluid embolism and a pulseless heart for 10 to 15 minutes – should have been fatal but wasn’t by God’s unimaginable grace.

Well, I reason, neurosis can’t be the only thing I get out of this.  And my prayer: Why was I given these experiences?  Not really Why as in Why me (although I’ve raised my hand about this a couple of times)?  More like, What for?  What follows is meant to be a note of encouragement to those in the midst of suffering and anguish.  Purpose in the pain.     

My God, My God.  I used to be quite a different person, a fact to which many can attest.  One might call it defending the faith, championing orthodoxy, knowing what I believed, not suffering fools, being a “solid” Christian.  In hindsight, though I still hold many of the same theological beliefs, it was chaff.  What suffering brought into my life was the priceless “I don’t know.”  God no longer fits into my well-read and meticulously reasoned box.  I can no longer put a pretty little spiritual bow onto my experiences.  At this point, God suddenly because bigger and more personal than I ever imagined.  My nakedness, my helplessness gives me the correct perspective and position from which to view the Almighty.  My stunned silence stills my voice to hear His, the gentle, the true, the tender, the passionate words toward me.  Suddenly, all the words of the great Christians souls, from the age of monasticism to the reformers to modern-day doers of the Word make perfect sense and in no way contradict one another.  It is a different way of understanding God, a God who utterly defies systematic thinking and three point sermons.  It was Jacob who wrestled and was crippled, who came to know the touch of God, His scent, His form.  What is our suffering compared to the privilege of experiencing God?

Many waters and love.  Love doesn’t quench!  I’ve seen it with my own eyes.  Good thing that’s what I had engraved in his wedding band.  I watched my marriage transform from the common union of two young lovers into an grand, epic tale, because my husband made a vow before God and chose to honor it.  Together, we’ve walked to the limits of the physical and psychological and found our way back, me Frodo, he Samwise.  God was there, so we three, we have a bond and memories which can never be erased and forever hold us together.  My husband and Immanuel held vigil over me, forgave thousands of transgressions against them, saw beauty where none remained, supplied when I had absolutely nothing to offer in return.  I gave them both leave to walk away, but they said they loved me and this is what love looks like.  I understand it now.  I know how to do love too now, because of God as Himself, God in my husband.

The world.  …is a messy place.  Suffering has allowed me to feel it in my bones and in my soul.  There is no denying the sheer weight of pain and confusion burdening all of humanity.  No longer any way to distract myself from it, having imbibed it.  And this is what my God would have – a taste of suffering to lend urgency to the task at hand.  The suffering, perseverance; perseverance, character; character, hope progression is not for us alone, but for all His love in us touches.  I have the blessing of not having to outline theoretical rhetoric to you.  All I have to do is tell you my actual story.

Miracles.  And yet grace abounds everywhere.  I don’t know how many years I had been thyrotoxic before the Grave’s diagnosis at the ripe old age of 23.  Figuring my target heart rate never worked for me in high school; mine was always running amok.  And yet, he sustained me, through track meets and several trips overseas in scorching temperatures and high altitudes.  I didn’t know, and He didn’t mind holding me.  In psychosis, always a beam of light when the abyss seemed bottomless, always a word of hope whispered.  In pulselessness, a gentle push toward a vision of my husband and children, an unreasonable but strong and prevailing calm.  How would I have known and seen that the world is so stuffed full of miracles had I not encountered the storms at sea?

Visceral is the word I’d use to describe it.  The keen awareness of my fragility and my mortality has made all of life much more visceral – God, His love, His work.  Instead of contemplating my spirituality, I’ve become the spiritual organism and can finally feel my own organs.  So valley of the shadow of death to the house of the Lord, the abode of life.

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