Tuesday, June 21, 2016

Mental Illness in the Bible

Something different here -- a sermon from the batshit crazy preacher --

[When I Googled mental illness in the bible, I was, frankly, appalled by what came to the top of the page. So I hope this banal title will make a better message easier to find. If you share this post, you can do that service.]

Now to the sermon:

1 Kings 19:1-15
Psalms 42&43
Luke 8:26-39

I don't often preach about mental illness. I'm not sure I have ever heard more than a mention of it by any other preacher. But today the lectionary asks us to tell stories that are not told.

Because we are no strangers to mental illness,and neither is the Bible. There's Saul, his bipolar episodes and his suicide. There's Job and Jeremiah, hardcore depressives. There's neurotic Paul himself, though that diagnosis has gone out of fashion. And Ezekiel, well, you'll have to read him and decide for yourselves.

Two people in today's lessons -- we'll start with Elijah.

Elijah didn't have a history of depression. His is called situational depression. Or maybe PTSD, Post Traumatic Stress Syndrome. You could surely expect that.

The prophets of the LORD, Elijah first among them, were at war with Ahab King of Israel and his Queen Jezebel. It was an ugly war. Prophets were massacred, the LORD's prophets by Jezebel's people, and then Baal's prophets by Elijah himself.

So Jezebel had a contract out on him, and he was hiding. In terror and trauma, without friends, without support, without safety, and in the wilderness, without water, he sat down under a bush, and said, Take me Lord; just kill me now. With that he fell asleep, hoping to not wake up.

There is a saying in suicide prevention. Suicide happens when pain exceeds resources for coping with pain. Two things about that saying are genius. First, it makes sense when survivors can't find some reason that seems "good enough." Sometimes people who die at their own hand don't have some immediate horrible event that explains the desperation of their act. Sometimes the last straw is just that, a straw. But it is the one last straw too many. Suicide happens when pain, whatever that pain is, on top of whatever else pain there already is, when pain exceeds resources for coping with pain.

There was that time I could not install the software on my brand new HP printer, for which I had paid far more than I wanted. Now that's not a reason to commit suicide. I know that. But I was so close to the edge, a puff of wind could have taken me over. I screwed up my courage to make a phone call.

It was some guy sitting in a call center in Mumbai who saved my life that day. He stayed on the phone with me for an hour, talking about Indian cinema, while he patched into my printer and downloaded the repair.

Suicide happens when pain exceeds resources for coping with pain. See, the second thing about that saying, it offers hope. It gives us a strategy. Somebody you know is facing -- whatever it is, it's too much. Take me, Lord; just kill me now.

You don't have to be brilliant, solve some intractable problem, lift the weight of the world. You yourself helps. All kinds of things help. Here Elijah, while you were napping, I baked you a cake. Tell me your story. And after you fill up on carbs, take another nap. I'll clean up, and fix supper for you.

Rested, fed, supported, and heard, Elijah was pulled back from the edge, and had enough to go on.

Now the Gospel. The Gerasene demoniac appears to have had schizophrenia, at least psychosis. He lived on the streets, no clothes, you can almost smell him off the page. Hear him, too, when he talked to his demons. People with schizophrenia tell me it helps. When the demons call them horrible names and tell them to do horrible things, it helps to argue back. But it does scare others, to hear a smelly, dirty, homeless man angry, and shouting at the voices.

He never hurt anybody but himself. Mark says he would bruise himself with stones. But they put him in chains because? -- they were afraid.

You know, this week it occurred to me, I call him the Gerasene demoniac. That's what it says in my Bible, the headline across the top of the page, meaning the person from that part of the country who was possessed by demons.

Demoniac -- it's like calling somebody a schizophrenic. You know, that schizo downtown? Mental health advocate that I am, I know not to do that, not to name him by one part of him. Put the person first. A person with schizophrenia, not a schizophrenic.

It's on the page, but Gerasene demoniac is just the headline. The text itself, the Gospel writers don't call him Demoniac. Jesus doesn't.

Jesus asks him his name. Now it's the demons who answer. We never do learn him name. But Jesus recognizes the difference between the person and the symptoms And he treats them differently, the person and the symptoms. The symptoms he gets rid of. The person he clothes, and returns him to his community.

Respect. Jesus treats him with respect. Because Jesus knows who he is. He is a child of God.

I have a laminated card from NAMI, National Alliance on Mental Illness. It's about how to handle a mental illness crisis. When you know what to do, you don't have to be so scared. You can behave a lot better. And you can help. Just like knowing first aid.

The card lists behaviors that someone with a psychiatric illness might display, and the corresponding things that you, in response, need to do.

Someone with a psychiatric illness might have trouble with reality. So you need to be simple and truthful. Might be fearful, so you need to be calm; have poor judgement, so don't expect rational discussion; have trouble concentrating, so be brief and repeat; have changing emotions, so disregard the changes. Have little empathy for you, so recognize, it's not personal -- it's a symptom.

When I have used this card, I add an item that the original omitted. It comes out of my own experience. Someone with a psychiatric illness might feel shame. So you need to show respect.

The essential point here -- do what Jesus did. He recognized the symptom. And he respected the child of God.

That's the way he treats us all, fearful or not. In our right minds, or not. On our best behavior, or not. Children of God.

It's a hard thing, mental illness. We don't talk about it, because it scares us. But there is no bigger monster than silence.

The Bible is not silent. It gives us an opportunity, and it gives us resources. Faithful people can talk about the hard stuff. People of faith can talk about anything.

Well, yes and no. Sometimes faith fails, in the face of shame, and in the face of fear. In my darkest hours, my faith did fail. Our psalms today say, Put your trust in the Lord; for I will yet give thanks to the One who is the help of my countenance, and my God.

Well, I didn't. I didn't trust a God who, I could only believe, had let me down.

That was hard. Mental illness can take away so much. It can take away faith, memory, identity. I didn't know who I was, if I didn't have faith. I didn't know how to be a person without faith. But there it was.

There are psalms that put words to that confusion and despair. Most of them end on a word of hope, for I will yet give thanks to the One who is the help of my countenance, and my God.

At the time, it hurt to read those words. They seemed a lie.

But there is even a psalm for when we do not believe. Psalm 88 tells the story of despair, and it ends, Darkness is my only companion. That is the last line, the end. Darkness is my only companion. The Psalmist heard my truth, and spoke it, and let it be, let me be.

I wrote a friend I couldn't say the Daily Office anymore. I was having trouble even brushing my teeth. He answered, he couldn't help with the teeth, but not to fret -- he would do my praying for me.

You know what, that helped, to let go of praying for a while, knowing that even while I could not believe, still I was held within a believing community. That's who I was, part of the communion of saints.

And something else helped, Gospel music. Here is something I wrote in those days, about ten years ago:

The lament psalms persist in worship, and worship is how I persist. I listen to Gospel music. I sing along with those whose music it is. I do not have their faith. But I cannot dispute their testimony, what God has done for them, and the power they find in God to get through. I believe in them. I believe in the Brooklyn Tabernacle Choir.

Those whose ancestors survived the Middle Passage, survived slavery, survived Jim Crow, survived the Klan, those who still survive today, I don't know how they survive. But they assure me, and I listen to them sing to me:

Everything He said, in His word,
He will do it for you.
Every prophecy He gave, every promise He made,
He will do it for you.

I didn't believe the words. But the music carried me through.

The Psalms are music. They were written to be sung. Their poetry puts words to our deepest truths, our deepest loves, griefs, rejoicing, even rage, when our own words frighten us and fail. They give us voice, and put it to song.

Every hymn I chose this morning comes from the Psalms. It's all in there. Our stories are in here. Even when we can't speak our truth, and mental illness is just one of those truths we find hard to speak, we can find it here.

Whatever that truth is, we are held, we are respected, we are known as children of God.

So I do give thanks to the One who is the help of my countenance, and my God.  Amen.

painting of Elijah in the wilderness by Daniele de Volterra, c. 1550, in public domain
Flair from Facebook.com
medieval illustration of Jesus casting out demons, in public domain

photo of shadow by Cornava, used under GNU Free Documentation License

Monday, February 1, 2016

Not Just Up and Down -- A New Map for Bipolar

Last week a friend told me she had just been diagnosed with bipolar.  I remember eight years ago when she told me she was finally getting treatment for depression.  I didn't say it at the time, but for the next several days my brain was screaming it: Really?  In 2016 people are still being misdiagnosed, and mis-treated, mistreated with meds that make them worse.  I mean, 

F*cking Really?!!

Lives are at stake here, people.  Careers, families, credit, and yes, lives. That is what people lose when their doctors get this call wrong.

Nancy Andreasen, world prominent researcher of schizophrenia and former editor of the American Journal of Psychiatry once wrote, Since the publication of DSM-III in 1980, there has been a steady decline in the teaching of careful clinical evaluation that is targeted to the individual's problems and social context and that is enriched by a good general knowledge of psychopathology.

What replaced careful clinical evaluation were the damned symptom lists.  The DSM was supposed to make it easier for researchers to talk with each other and check each other’s work.  But when clinicians, the people who treat patients, got hold of the lists, they stopped listening to patients and started comparing us to what we were supposed to look like.  Count the symptoms; assess severity; assign the diagnostic code.

As a consequence, the lists, which were actually rough drafts until DSM-III carved them in stone, turned into circular arguments.  They could never be significantly improved, because when the researchers wanted to learn more about bipolar, they went out and got a bunch of people who already matched what they thought bipolar was.  Deviations were excluded from studies, and so were not able to provide better data.

Downstream from the lab, patents became chained to lists.  We have to learn the language of the DSM, because that is the only language our doctors speak.  Unless we report what matches the lists, our complaints are not heard and not treated; our suffering is not known, let alone addressed.

How many times have I reported to a doctor that my body doesn’t regulate temperature well?  That might illustrate a pattern of difficulty maintaining homeostatsis, like any number of disregulation issues related to bipolar.  But it’s not on the list, and they really aren’t interested.

Shortly before DSM-5 was published, Thomas Insel, director of NIMH declared that treatments for mental illness were just not good enough.  He announced that NIMH wasn’t going to fund research anymore that depended on the damned lists.  It’s time to stop reading the list of features pasted to the car window and start looking under the hood.

Up steps John McManamy to say:
       Look under my hood!

In Not Just Up andDown, John tells the story of how medicine got to such a distorted view of bipolar – the very name of the disorder confuses doctors, patients, and public alike as to the nature of the beast.  He provides his own careful clinical evaluation.  And he proposes a different map to follow to connect the dots.

He tears up the book, looks at the patient, and finds a new way to explain what is going on, exactly what Insel says we need to do.  Finally!  Here is somebody paying attention.

Actually, John goes back to older books.  For thousands of years before DSM-III, people did pay attention.  Well, if you are not blinkered by your presuppositions, bipolar can be hard to miss!

From Galen and his four humours paradigm, through Jean-Pierre Falret with la folie circulaire (circular insanity) describing the continuous pattern of depression, mania, and 'normal' that he observed in his patients,

to Emil Kraepelin's"manic depression," which included the whole domain of periodic distress (including "recurrent depression"), and on to the whole posse of modern experts,

Frederick Goodwin and Kay Jamison who wrote the book, The Book, Manic Depressive Illness,

and researchers Nassir Ghaemi andHagop Akisnal, along with clinician Jim Phelps who all talk about the bipolar spectrum, these people developed their theories by paying attention to what was sitting in front of them, Nancy Andreasen's careful clinical evaluation.

Not Just Up and Down follows this long historical interpretive thread of a long observed malady, that of cycling. McManamy explains the train wreck of DSM-III, with its separation of unipolar  depression from bipolar.  He fails to explain how this radical departure from the observations of millenia (snuck in through a single university's rough draft of symptom lists) has persisted in opposition to the smartest names in the field, from DSM-III's publication in 1980 to DSM-5, thirty-three years later.  But the writers of DSM really need their own diagnostic code, different from the one on which John is working.  I have an idea what that code would be, and who would get it, but in the absence of a careful clinical evaluation...

The major contribution of Not Just Up and Down is the careful tracing of how all the parts under the hood connect to each other and in the lives of real human beings.  We need to start over, Thomas Insel has announced.  McManamy offers up his own map as a start, connecting trauma/stress, sleep, resilience, mood, thought, personality/temperament, energy, anxiety, seasons...

John is an expert patient. He has read all the journal articles, attended all the conferences, knows his science.  And he also knows himself. 

Know thyself has always been John’s mantra.  For those of us who have to live with this thing mis-named bipolar, it is how we can move from surviving to recovery to reclaiming our own most excellent selves.

Oh, and it’s a very funny book.

flair from Facebook.coim
photo of bible in public domain
photo of book burning by Patrick Correia, used under Creative Commons license
book cover from Amazon.com
photo of train wreck at Montparnasse, 1895 in public domain
photo of Socrates by John McManamy, used by permission

Monday, March 30, 2015

World Bipolar Day -- Happy Birthday, Vincent

Today is Vincent Van Gogh's birthday.  Some people give him a post-mortem diagnosis of bipolar disorder, and take the occasion to declare World Bipolar Day.  Healthcentral.com contributor John McManamy says for him, every day is bipolar day.

As for the world in World Bipolar Day, precisely which world are people talking about?  In my memoir, I note:

Maybe someday, aliens will kindly abduct me and return me to the planet of my birth.

In the meantime, I'm stuck on this one, not a planet of my own choosing, performing my own stunts, learning as I go along.  As I like to joke: We're peanut butter people stuck in a tofu world governed by Vulcans.

Back to the beginning: Bipolar is not for a day.  Let's instead celebrate our bipolar lives - the ups, the downs, the bad, the good, the ridiculous, the sublime.  Give lip-service to normal, but stay true to bipolar.  After all, it's who we are.

I like John.

Yeah, I haven't been posting much lately.  I have a friend who checks up on me when I stop posting. But in this case, it's because I am doing so much and well enough that something had to give.  I have missed blogging, and am trying to keep my hand in at batshitcrazypreacher.blogspot.com.  So go there, if you want to follow what I am up to.

Back to the present occasion -- I give thanks today for the life of Vincent. And I share the following in honor of my fellow peanut butter peeps.  I rejoice in every day they spend on this planet.

Wednesday, September 10, 2014

World Suicide Prevention Day - Keeping It Simple This Year

Two things I wish everybody knew:

No matter how you package it, shaming suicide does not prevent it, and

Understanding never pushed anybody over the edge.

photo of candles by Nevit Dilmen, used under the GNU license.

Friday, August 15, 2014

On Surviving - I Wish Robin Williams Had

Nearly a week's worth of reporting on Robin Williams' death, some of it heartfelt, some of it educational, some of it ignorant bloviating -- even if you have been living under a rock and not heard any coverage at all, you can name the bloviators, can't you.  By now, my readers surely wonder, What is the Prozac Monologues take on his untimely death?

I have written reams on suicide and suicide prevention.  Click on those two links and take your pick.  But skip the Suicide Monologue, at least for another week.  It is inappropriate for another week.  And if you do go there, then mind the humor alert.  I am serious -- about the humor alert, that is.  Some of you won't find it funny. It wasn't written for you.

But before we abandon the suicide conversation in favor of the next thing, let's expand the frame.  Here's the deal.  Of all the people alive on the planet today, 50,000,000 will, at some point in their lifetimes, struggle with suicide.

I can't say we will think about suicide.  Those of you who think about it in passing seem to think that the seriously suicidal think.  There is lots going on inside our burning brains.  But thinking doesn't really describe it.

Anyway, of those 50,000,000 pitiful souls, 5,000,000 will die at their own hand.  That number could be a lot smaller, if there were sensible and serious suicide prevention available to anybody who needs it.  Suicide happens when pain exceeds resources to deal with pain.  We could use some more resources.

But let me remind you that Robin Williams had loads of resources, loving friends and family, economic security, and excellent health care to boot.  And he used those resources.  For years, decades, he used those resources.  They weren't enough.  Depression killed him anyway.  Like how people with health care can recover from cancer.  But some of them, even those with the best health care in the world, die of cancer. Just like that.

Back to the 50,000,000.  Do the math.  45,000,000 people are alive today who will at some point in our lives struggle with suicide, and will survive.  Note that I am placing myself, God willing, among the 45,000,000.  I have loads of resources, too, among them the good sense not to own a gun, which significantly improves my odds of survival -- a side note there.  But back to my point.  Gosh, I am having trouble sticking to the point.  Psychiatry has a word for that...  But back to my point.

What about the 45,000,000?  We are cautioned this week.  We are reminded that we struggle against a fearsome beast.  We cannot be careless.  We have to get rid of the damn gun, and the leftover meds, too.

We also have to live.  We have to celebrate every day a victory.  Those of you who love us, maybe you could, too.  That would be really nice, to have somebody celebrate that we are surviving depression, like you would celebrate our surviving cancer.  Why not bring us some flowers?  Or bake us a cake?

If you are one of the 50,000,000, aspiring to be one of the 45,000,000 -- don't wait for somebody else to bake you that cake.  Bake it yourself.  Even if nobody around you celebrates, there are 50,000,000 people alive today who know something of what you are going through. And we rejoice that you are still here.  We are all in this together, us 50,000,000, even if we do not speak a word when others are bloviating about those of us who stumble on the way

In that spirit, I repeat a post from September, 2009:

Cut the top ten and go straight to the number one reason why Willa Goodfellow should never get herself committed to the psych ward:

I suck at arts and crafts.

I didn't used to.  I used to produce Christmas cookies and gingerbread houses that made adults and children alike respond, "Oh! My! God!" -- though not the way this cake does.  I used to make big gingerbread houses.  No kits. and no showing off with royal icing and special decorating tips (which might have improved this cake, if I had been able to find them).  I used Golden Grahams for shingles, individually placed sprinkles on the door wreaths, graham bears ice skating in the yard, pretzels for fences.  I made Dr. Seuss-like trees out of marshmallows and gummy savers, M&M's for roofing material, or maybe candy-canes for the Swiss chalet touch -- those were a bitch to hold in place until the frosting glue dried.  Once I used peanuts to construct a fire chimney.  All color coordinated.  I must have made thirty of those suckers, and each an original masterpiece.

Then I took Prozac.  And Celexa, and Cymbalta, and Effexor.  And part of my brain has never come back.  I think the part that departed included the "good taste" part.  Also the "give a damn what you think" part.

This cake and the guerilla party I held in the hospital lobby to celebrate the 45,000,000 people at risk for suicide who will survive it, the same hospital whose psych ward I hope never to call home, definitely come out of the Prozac Monologues spirit.  So does the grammar of that last sentence.

This one, I am submitting to cakewrecks.com.  So, Elaine, (a friend who happened by the party and was speechless) you can go ahead and say it.  Yes, I know.

Some people actually do get it.  One of the guests was a psychiatrist who laughed along when I bemoaned having thrown away all the meds I have stopped using over the course of the Chemistry Experiment, so that I was reduced to Smarties and Mike and Ike for decorating material.


"I have a dream. Okay, technically it's a fantasy." [Elmont, Doonesbury]  That when people who survive self-injury are transferred from ICU to the psych ward, they will be greeted with a cake.  That when they get home, there will be a party, just like the party that will greet my friend who just made it through colon surgery.  A quiet party, befitting the energy level of the guest of honor.  But a party with a guest of honor, for having survived this latest round with a disease that has a 15% mortality rate.  I have a fantasy that people who survive self-injury, or manage to avoid it altogether, will be treated like people who survive breast cancer.

I have a fantasy that next year the Psych Department itself will host the party for Suicide Prevention Week, with both Emergency Room workers and the patients, out on a pass, sharing the honor.

For sure, the hospital-catered cake will look better.

photo of Robin Williams by John J. Kruzel/American Forces Press Service, in public domain
flair from Facebook.com
photo of cake by author
photo of Prozac by Tom Varco, used under Creative Commons license
photo of miscellaneous pills used under Creative Commons license

Friday, May 2, 2014

Antidepressants and Suicide: Defending Prozac

It amazes me how many research scientists seem to have flunked statistics.  Or ought to have.  Me, I majored in the liberal arts.  But at Reed, even those who took Science for Poets would be required to rewrite some of the scientific papers I have read on the subject of antidepressants.

So the vocabulary terms for the week are observer bias and confounding variables.  No worries -- lots of pictures.

Clinical Experience in Defense of Prozac

Let's say you are a doctor treating 100 patients with severe depression.  You give them all antidepressants.  It seems irresponsible not to, doesn't it.  Thirty of them get better.  Fifteen do not make a follow-up appointment.  You switch the fifty-five who are still trying to another antidepressant.  Another fifteen get better.  And another fifteen do not make a follow-up appointment.

Over the course of a year, you get up to fifty whose depression is remission and ten who are still struggling.  You don't know what happened with the forty who are no longer seeing you. They couldn't afford treatment; they didn't like your face; they couldn't find parking; they got worse on your medication. You have no idea.  But you have fifty patients who think you saved their lives.  You feel pretty good about yourself, don't you.

Friday, April 18, 2014

Antidepressants and Suicide: A History

Do antidepressants prevent suicide, or do they cause it?


Well, maybe.

It's a no-brainer, right?  People who commit suicide are depressed.  Take away the depression, and how better than with an anti-depressant, and you decrease the risk of suicide.

So what's with the question?  Here is the story:

History of Antidepressants