Recently there was an article in USA Today about a pastor in the Carolinas who committed suicide. Here’s the article. I would urge you to go and read the entire article, but here is an except:

Those who counsel pastors say Christian culture, especially Southern evangelicalism, creates the perfect environment for depression. Pastors suffer in silence, unwilling or unable to seek help or even talk about it. Sometimes they leave the ministry. Occasionally the result is the unthinkable.

Experts say clergy suicide is a rare outcome to a common problem.

But Baptists in the Carolinas are soul searching after a spate of suicides and suicide attempts by pastors. In addition to the September suicide of David Treadway, two others in North Carolina attempted suicide, and three in South Carolina succeeded, all in the last four years.

Being a pastor — a high-profile, high-stress job with nearly impossible expectations for success — can send one down the road to depression, according to pastoral counselors.

For the most part the article is really quite good in nailing the problem. One sentence in particular really grabbed me:

Society still places a stigma on mental illness, but Christians make it worse, he said, by “over-spiritualizing” depression and other disorders — dismissing them as a lack of faith or a sign of weakness.

Isn’t that the truth! Christians are horrible at addressing mental illness, because we equate the mind with the soul, and presume that if someone has a mental illness that it is at the root a spiritual problem. Now I will be the first to grant that mental illness always has a spiritual component, but arguing that clinical depression or other mental illnesses are simply spiritual is irresponsible, and borders on a denial of the First Article.

God created us, body and soul. Because of sin, we feel the effects of the Fall throughout our entire existence, body and soul. It is entirely right to say that sickness and disease are the results of sin, but it is also true that God has given us many tools to heal, body and soul. The chief of these is the healing Word of God. But there are also many other methods of healing that God has provided, including medication, doctors, therapy, etc. Can these be misused or abused? You bet! At the same time, I would suggest that the “spiritual card” can also be horribly abused. If I tell someone who is mentally ill that they need to pray more, or spend more time in the Word, or come to Church, and that this will simply heal them apart from these other tools, I am saying that God only works through the Word and not at all through any other means. I’m not sure what to call that. But it isn’t right.

We pray for the families and congregation of this pastor, and hope that God will use this as an opportunity to bring healing and help to so many who are in need.

Be at peace,
DMR

Friends,

As many of you know, the book has gone extremely well thus far.  So well, in fact, that they are already out of print!  We were able to offer them at no charge thanks to the generosity of LCMS World Relief & Human Care.

This brings me to my plea.  Every box or book that went out included a donation envelope.  They are currently trying to figure out how to do a second printing, but I expect it will come down in part to dollars and cents.

If you received a copy of the book and found it of benefit, I would ask you to consider making a donation to LCMS World Relief.  You can send it and ask if they would consider reprinting it.  I know that everyone want to do so, but finances are tight everywhere right now.  Obviously I am biased, but I believe that a copy of this book ought to be sent to every pastor in the LCMS, or at least every circuit counselor.  But to do this will cost several thousand dollars.

I’ll keep you all informed as I learn more.  Thanks again to the good people at LCMS World Relief and Human Care for making this resource available!

-Pastor Todd Peperkorn

In the last few years I have had the opportunity to speak or correspond with many people who struggle with depression or other mental illnesses. Pastors, teachers, DCEs, laity, each story is different, yet there are common themes.

One of those themes is how often the church, either at the congregational level or at the district/synod level, has failed these people. In all too many cases, their faith has been shaken to the point of disappearing. Now I don’t believe that there is any malice on the part of congregations or our church body. Far from it. But the sad reality is that we are driving people away from Christ by how we approach the mentally ill.

Why?

I have several theories about this. Here they are, in no particular order:

1. Because we so often equate clinical depression (or any mental illness) with some sort of character flaw, it is viewed basically as a sin. I think people instinctively know that this isn’t quite right, but they don’t have any other categories in which to place mental illness.

2. Everyone has weaknesses, and we work very hard to hide them. For many, depression unmasked is too close to home. It forces us to view our own struggles and failings, and that may just be too painful.

3. If we view the church as a place for the spiritually strong to work out, and not a hospital for the sick, then the mentally ill have no place.

4. The fundamental notion of “depression is in your head, get over it!” is so strong that we can’t help but judge others whose weaknesses are in public view.

5. Lutherans just aren’t very good at areas which aren’t “spiritual” in nature. If it isn’t about justification, then we just don’t get it. Hence, we try to place depression and mental illness simply into the “spiritual” box, and it doesn’t fit there.

Those are off the top of my head. What’s on your list?

I am currently laid up with a physical illness. Nothing serious, so don’t fret, but it reminds me again of how differently we treat physical and mental illness. Here’s a little compare and contrast:

1. In physical pain, we seek to find the cause and solve it. In mental pain, we try to suppress it.

2. In physical pain, the one in pain receives sympathy and care. In mental pain, the sufferer is avoided because they are somehow tainted or weird.

3. In physical pain, the congregation prays for the afflicted. In mental pain, the afflicted suffers alone because mental pain is never shared.

4. In physical pain, the assumption is that this is not the sufferer’s fault. In mental pain and illness, the assumption is that there is something wrong with the person.

Those are my initial comparisons. What’s on your mind?

-DMR

One of the questions that regularly come up to me has to do with the ons and offs of medication. When and why do you go on medication, and when and why do you go off of them? While the two are related, they are not the same.

Why go on medication?

We go on medication simply put because we need it. There may be many factors which go into that decision. It may involve mood, basic functionality, self-image, the ability to handle situations or stress, being able to interact with other people, to keep us safe from ourselves or others. You know your own list. For myself, I knew I had to go on medication when I found myself hating the things that I love: my family, my wife, my vocation as pastor, even my hobbies and the things that I enjoy became a burden. I couldn’t handle living any longer, and so something had to change. While one can go the route of simply counseling or natural remedies, in my view and after much reading on the topic, I simply haven’t found any cure or natural remedy or counseling method that is more effective than anti-depressants. Can you go other routes? Yes. Can they be effective? Yes. But I don’t believe that they will work as quickly or as well as modern anti-depressants or anti-anxiety medication, and the body of research seems to continue to support that view.

That’s why I went on medication, both initially and that’s why I went on them the second time.

Why go off medication?

The reason we go off medication should be fairly simple: we go off medication because we no longer need it. Now that sounds very simple, but we often invest massive amounts of emotion and other negative energy into the decision to go off of medication. Here are a few that I see and hear pretty regularly:

1. I don’t want to become addicted.
2. I don’t want to be on medication for the rest of my life.
3. Taking medication makes me feel weak or out of control of my own body.
4. I don’t like the side effects.
5. I can’t afford to take them anymore (iow, money or insurance problems).
6. I have found a better alternative way of treatment.

Now out of that list (and I look forward to hearing yours), four of them are basically emotional responses to medicine (wants and likes and feelings), one is money based, the the final one is experimenting with others ways of treatment.

But remember that initial reason on why we go off medication: we go off medication because we no longer need it. Unless you are a doctor, it is very unlikely that you will be able to determine when you no longer need it, since the medicine working is what makes you have a normal, functional life in the first place.

So how do you know when you don’t need the medication? Here’s a tip: you can’t know by yourself. You’re not a doctor, you’re not a pharmacist, you’re not God. It takes outside evidence. It takes some level of expertise that most of us do not have. It’s why God gives us doctors and nurses and medication in the first place.

If you think you want to try going off your medication, I would suggest the following steps:

1. Wait a month.
2. Talk to your doctor about the possibility of going off medication.
3. Wait another month.
4. Talk to your spouse about it, and anyone else whom you trust that may have some wisdom on the subject.
5. Wait another month.
6. Talk to your doctor about it AGAIN.
7. Then come up with a reasonable timetable and a way of evaluating what changes happen as a result of going off the medication.

One thing is for sure. Don’t willy nilly try to do this. Don’t just decide you are going to “see how you feel” by stopping to take it for a while. That is just not wise.

If you are desperate, send me an email and we’ll talk about it directly. I’m happy to pool my wisdom/foolishness with yours.

Be at peace,
-DMR

The link below is from the blog Untreatable Online, which I read pretty regularly. As a Christian, my question is this: how should we as the Church serve these people? How do we demonstrate or mercy for the needy in care here? Talk about a tough question! I wish I had a good answer…

Frontline The Released Article

This is not any kind of great insight, but simply a realization I had this morning. I just had two nights in a row where both my wife and I were present to take care of the kids and get them to bed. Reading, catechism, prayers, etc. It is the first time we’ve had that for two nights in a row in WEEKS. AND we get to do it again tonight.

Wow.

I can just feel myself relax and settle into the normalcy of life when such things happen. I feel like I have been wound up since before Lent, and that things are just now starting to rebound and come down to the usual chaos.

It is so important to simply have time to be a family, to gather together, to sing and pray, play outside, chase around, and do whatever you do in your family. I am grounded when these things happen. My mood improves, my patience improves, everything is better.

But I can’t see that when I don’t have it. I get so obsessed with GETTING STUFF DONE that I forget who I am as a child of God, as a husband and father and pastor and neighbor, etc.

Be at peace, friends. Get some rest. Don’t try to get everything done, for you may lose yourself in a series of tasks that seem important at the time, but ultimately don’t really matter.

-DMR

Who Switched Off My Brain?
By Dr. Caroline Leaf

A parishioner of mine recommended this book to me, and so I read it a couple weeks ago. I checked it out from the library, so I don’t have it in front of me, but I wanted to give a brief review of it at least.

The author is I believe an evangelical Christian of some stripe. Basically what the book does is tries to explain in lay terms how the brain works, and the role that what she calls toxic thoughts and emotions have on your physical, mental and spiritual well being.

I found the book extremely helpful. It is easy to read, explains a lot of the things that many of us sort of know or suspect but can’t really explain, and does so in a positive, useful fashion. If you are trying to get a grip on how your mind works and why, this is the book for you.

I would also say that it would reinforce cognitive therapy in a general sense. Which I count as a very good thing.

My only caveat on the book is that because of her american evangelical background, she looks at forgiveness simply as a choice that one makes, and not as a gift given by God through the Word and faith. This didn’t distract me overmuch, but it is a caution. This, by the way, is also my general caution regarding cognitive therapy. It is a good and salutary method of counseling, as long as we can understand the role of God’s Word in creating faith in the process.

Anyway, it’s a good book. I recommend it, and I’ll probably buy it somewhere along the way here.

-DMR

This is no great revelation to me, but it is worth highlighting. Exercise releases lots of good endorphins and other “stuff” to help improve mood and disposition across the board.

Check it out.

Now if I could only get myself to act on this knowledge…

-DMR

Improving Mood And Serious Mental Illness With Physical Activity: ”
 
A new study from Indiana University suggests that even meager levels of physical activity can improve the mood of people with serious mental illnesses (SMI) such as bipolar disorder, major depression and schizophrenia.

The study, published in the November issue of the International Journal of Social Psychiatry, both reinforces earlier findings that people with SMI demonstrate low levels of physical activity…”

I don’t generally think of Robert Preus as the source of all knowledge when it comes to mental illness, but I ran across this article recently. It is well done. Very Preusesque, but he really understands the relationship between faith and mental illness. Here’s one citation to pique your interest:

Pastors who suffer stress and affliction, like any Christian in similar circumstances, may be tempted to look to their faith as a reason for self-esteem and assurance, rather than to the only object of faith, Christ and His pardoning Word. They conclude that failure and inability to cope are due to weak faith or the lack of faith altogether. They are viewing faith as their act rather than as their reception of God’s mercy.

Robert D. Preus, “Clergy Mental Health and the Doctrine of Justification,” Concordia Theological Quarterly 48, no. 2 & 3 (1984): 120.

I recommend this little essay very highly. Check it out. I actually think that LCMS World Relief has this online somewhere, but I can’t find it right now. Can anyone help me out?

-DMR