Category Archives: depression

book reviews, depression, psychology

Response from Dr. Yahnke

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In the previous post regarding the book, Sophie’s Choice, I referenced a fine paper by Dr. Beverly Yahnke. A couple of people raised questions about whether she was advocating the breaking of the confessional seal in the second to last paragraph of her paper. I took the liberty of contacting her directly about this, and this was her response:

DarkMyRoad invited me to review the most recent postings regarding my paper,”The Taxonomy of Despair” and I appreciate the opportunity to respond to the very appropriate concern raised regarding confessional privacy.

As one who treaures the practice of individual confession and absolution, I prize the confidentiality of the confessional and would never recommend that any pastor violate the privacy promised the penitent.

For the record, the Saint Louis speech was addressed to parish nurses, church workers of all stripes, family, friends and pastors of the despairing. Every single one of those individuals should seek external professional assistance to respond to a person who is acutely suicidal UNLESS that information is offered as part of individual confession and absolution. In that case, the pastor is always bound to protect the privacy of the penitent. (I presumed that point to be obvious to the pastors in attendance; hence did not feel the need to dwell on the matter.) I should underscore that most of the time, as the paper suggests, individuals in end stage self-loathing and seeking escape are not seeking an opportunity for conversation or confession. They are barely tolerating any care of any sort. In fact, the most frequent conversation about end stage despairing individuals often takes the form of a pastor who learns from a friend or a family member that a soul is dangerously pre-occupied with suicidal thoughts or self-loathing. If the soul refuses care and remains at risk, I believe that the pastor must act to provide appropriate safety in seeking care for the mentally ill — whenever the seal of the confessional does not prohibit it.

Dr. Bev Yahnke

There you have it. Does that make sense?

-DMR

book reviews, depression, Pastoral Office

Sophie's Choice

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I recently finished reading an intriguing book by William Styron entitled Sophie’s Choice. Styron is the same author who wrote Darkness Visible, which I have commented on before. As a disclaimer, I will say that there is LOTS of poor language, sex, and other generally in appropriate things in the book, and that as a Christian reading it, you need to be prepared.

Having said that, it really is an amazing book.

Sophie, a Polish refugee who survived Auschwitz/Birkenau, is haunted by the terrible things she did in Cracow and again at the concentration camp. She went face to face with a great evil, and in her mind, she failed. Depression doesn’t even begin to describe her mental state. She is suicidal clearly, and is in the midst of a bizarre abusive relationship that the reader doesn’t truly understand until near the end of the book. Her boyfriend is schizophrenic, and so goes through periods of extreme violence and periods of “normalcy” along the way. In the end, she and her boyfriend complete a suicide pact which they had aborted some months earlier.

[spoiler: don’t read this paragraph if you want to read the book and be in suspense.]
The choice which she had to make was which one of her children would get to live, and which would get to die. She is forced to make this choice because she was Polish; for the Jews at the time, all the children died. But she got to choose one to live. The ultimate evil, or pretty darn close.

Now a number of things about this book have gotten me to continue thinking about it. First, the obvious traumatic event which triggers as deep and dark a depression as one can imagine. There was no history of depression in her family. Of course, I expect that seeing those kind of horrors will change a person no matter what. But to be asked to choose which child lives, and which dies. That would be the ultimate breaker of a personality, I would say.

The second is her obvious desire for redemption and forgiveness, even though she has abandoned her Catholic upbringing, because God “abandoned” her. Here is a perfect example of where do you go to look. She tried them all. Music, alcohol, sex, living the wild side, the whole gambit. She went everywhere except to the One who could help. The narrator (Stingo) is also an agnostic, and so the thought never really occurs to him.

Finally, we can see in Sophie’s Choice the devastating effect that events and how they are interpreted in our lives can have on us. There is no happy ending or making good with choosing between two of your children, only to have both of them die in the end.

For the Christian, how one address people in pain and suffering is a critical understanding. On the one hand, we can’t simply dismiss despair in whatever form it takes as merely unbelief to be squashed. In sin, every sinner is both the participant and the victim. Our task (esp. as pastors) is to minister to them, to draw the sin out, and to provide healing that is real and lasting. A part of that means when it comes to despair that there are real reasons why people fall into despair.

It also means providing them with hope to give hope where it belongs, in Jesus Christ and him crucified. But this doesn’t mean pat answers. It means tackling tough questions, admitting when we have no idea, and weeping with those who weep.

There is a fascinating paper out in cyberworld that addresses this topic by Dr. Bev Yahnke. It’s called Prescriptions for the Soul: The Taxonomy of Despair. Read it. And read this book. I look forward to your thoughts on the matters

-LL

book reviews, depression, Pastoral Office

Sophie's Choice

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I recently finished reading an intriguing book by William Styron entitled Sophie’s Choice. Styron is the same author who wrote Darkness Visible, which I have commented on before. As a disclaimer, I will say that there is LOTS of poor language, sex, and other generally in appropriate things in the book, and that as a Christian reading it, you need to be prepared.

Having said that, it really is an amazing book.

Sophie, a Polish refugee who survived Auschwitz/Birkenau, is haunted by the terrible things she did in Cracow and again at the concentration camp. She went face to face with a great evil, and in her mind, she failed. Depression doesn’t even begin to describe her mental state. She is suicidal clearly, and is in the midst of a bizarre abusive relationship that the reader doesn’t truly understand until near the end of the book. Her boyfriend is schizophrenic, and so goes through periods of extreme violence and periods of “normalcy” along the way. In the end, she and her boyfriend complete a suicide pact which they had aborted some months earlier.

[spoiler: don’t read this paragraph if you want to read the book and be in suspense.]
The choice which she had to make was which one of her children would get to live, and which would get to die. She is forced to make this choice because she was Polish; for the Jews at the time, all the children died. But she got to choose one to live. The ultimate evil, or pretty darn close.

Now a number of things about this book have gotten me to continue thinking about it. First, the obvious traumatic event which triggers as deep and dark a depression as one can imagine. There was no history of depression in her family. Of course, I expect that seeing those kind of horrors will change a person no matter what. But to be asked to choose which child lives, and which dies. That would be the ultimate breaker of a personality, I would say.

The second is her obvious desire for redemption and forgiveness, even though she has abandoned her Catholic upbringing, because God “abandoned” her. Here is a perfect example of where do you go to look. She tried them all. Music, alcohol, sex, living the wild side, the whole gambit. She went everywhere except to the One who could help. The narrator (Stingo) is also an agnostic, and so the thought never really occurs to him.

Finally, we can see in Sophie’s Choice the devastating effect that events and how they are interpreted in our lives can have on us. There is no happy ending or making good with choosing between two of your children, only to have both of them die in the end.

For the Christian, how one address people in pain and suffering is a critical understanding. On the one hand, we can’t simply dismiss despair in whatever form it takes as merely unbelief to be squashed. In sin, every sinner is both the participant and the victim. Our task (esp. as pastors) is to minister to them, to draw the sin out, and to provide healing that is real and lasting. A part of that means when it comes to despair that there are real reasons why people fall into despair.

It also means providing them with hope to give hope where it belongs, in Jesus Christ and him crucified. But this doesn’t mean pat answers. It means tackling tough questions, admitting when we have no idea, and weeping with those who weep.

There is a fascinating paper out in cyberworld that addresses this topic by Dr. Bev Yahnke. It’s called Prescriptions for the Soul: The Taxonomy of Despair. Read it. And read this book. I look forward to your thoughts on the matters

-LL

depression, stimulation, stress

Globalizing

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I am having a bad week. Not a “I’m gonna die so just shoot me now” bad week. Just a bad week. Some things have happened that I don’t like, and while at one level I’ve “handled” them pretty well, made good decisions involving my own health, etc., it has not changed the fact that the fog has rolled in much more than I would like. I feel like I’m in slow moving quicksand, and I’m afraid of a relapse. I don’t want to go back to where I was even a month ago. I want to move forward, but I’m afraid.

This is what we might call Globalizing: taking an isolated event or time period, and extrapolating a whole series of future events that all work off the worst possible construction theory. Now everyone is susceptible to this. Everyone has their moments of despair and when you can’t see the future.

For one suffering from depression, globalizing is, well, more like solarsystemizing.

Instead of thinking of the stead progress that (by God’s grace) I have made over the last six months, I simply catapult back to the worst, the foggiest moments of my illness. It’s absurd. It goes against all of God’s promises for health and healing. It discounts medication, therapy, a supportive family, supportive pastor, and everything else good that has happened to me in the last year.

Yet it is how I feel. It is what I dread. My mind and body tell me that I am going to fall all the way back a year or more.

Is it true?

NO. It’s not true. I’m having some bad days. That’s all it is.

So what do you do when you’re slumping? You do what you know has helped you in the past. Here are a few of mine, but I’m sure you have your own list.

  • Get outside.
  • Golf
  • Work in the shop
  • Play chess or some other game (cards) that engages your brain elsewhere.
  • Spend quality time with your spouse.
  • Have some quiet, but don’t isolate yourself.
  • Pray

Those are a few. God’s peace be with you.

-DMR

depression, therapy

Venting on the WSJ on Depression

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HERE is an article by a WSJ columnist in their Opinion Journal section about depression in America. It really ticked me off.

It ticks me off because the author says this at the end of the article:

I suspect, however, that cultural differences can account for only so much. Economics must also be at work. Consider Jean-Baptiste Say’s famous insight that supply creates its own demand. We know this to be true about, for instance, personal computers: There was never any demand for PCs until Steve Jobs put one on the market and persuaded consumers it was something they should have. Just so with depression: Is there a country on earth where Prozac is more widely prescribed, or therapy more readily available, than the U.S.? It should hardly be surprising, therefore, that Americans now find themselves so depressed.

None of this is to say that depression is not, for those who suffer acutely from it, a serious matter or that it doesn’t warrant attention and care. But it is also true that what we now call “depression” is something previous generations also knew, albeit with different names: melancholy, unhappiness, “the blues.” In song, in church, in labor, in philosophy and in the bonds of family, community and tradition they were often able to find genuine consolations.

Such consolations still exist, though we no longer think of them as cures. Given how badly our own “cures” seem to be working, perhaps it would be well if we did.

Well, here’s the problem. There is nothing magical about the word “depression”. It is used colloquially for probably a dozen different diseases, maybe more. Some of those diseases are more common in different places. But generally speaking, any kind of illness of the mind can fall under the category of depression.

Furthermore, it is not simply a matter of consolation or of being happy. What a silly thing to say. The goal of life is not to be happy at the end of the day. Our goal as Christians is to be in communion with Christ, and to find our rest in Him. Even most other religions or secularists will recognize that “happiness” is not everything. I’m all for happiness, but please. Is that a medical diagnosis?

The same may be true for the word consolation. It evokes images of patting someone on the back when they’ve had a bad day, or simply sitting down and listening to a friend. Again, I’m all in favor of consolation. Consolation may be found in many different places, some of which the author listed. Consolation (I would suggest) is a portion of the healing which must come about in order to recover from depression. But it is not the “cure”.

Mr. Stephens, your article cited a lot of statistics, and pulled the public conversation about depression backwards, not forwards. I hope that you never have to suffer as we have suffered, but if you do, you will find your own words as painful as I do.

-DMR

PS Yes, I’m in a crabby mood today.

book reviews, depression, pharmacology

The Second Book I've Read: Prozac Nation

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Ten years ago or so, this book, Prozac Nation, was the hot ticket. Written by a young up-and-coming female writer, it was hailed as fresh and innovative, courageous, raw, and a bunch of other nice things. It was a part of a genre of self-disclosure that was (and is) extremely popular. But written just a few years after William Styron’s Darkness Visible: A Memoir of Madness, this book was written for the young and the restless. Lots of colorful language, a few titillating references to sex, and sort of a super-extension of teenage angst, the book had everything that other books of the genre lacked. It had a movie made about it. It was a bestseller, and so forth.

When I first read this book, early on into my illness, I found it liberating and deeply moving. It described what I couldn’t. Despite the sometimes whiny voice, it served an important purpose for me in understanding what I was going through. I wasn’t crazy; I had a mental illness.

I’ve read it again, and my views on the book are very different. It does describe the state of depression well. It does describe the roller coaster of medications pretty well also. It was, however, written at a time when Prozac was the first of a panoply of anti-depressants to come on the market. In many respects this is better, as more people have more options for healing. But this phenomenon has also added the maddening factor of doctors bouncing you from drug to drug, seeking to find the magic cocktail that will be the right fit. It can be a profounding frustrating and, well, depressing experience.

Back to Prozac Nation. After reading Styron’s book above, and others (which I’ll get to in due time), I find that Wurtzel is not as helpful as other memoir-type books of the genre. One of the dangers of reading memoirs like this while you’re in the midst of the illness is that it can give you ideas, prey upon your already overactive anxieties, and create a mental state which may not have been there at the start. It’s usefulness for those suffering from depression and anxiety comes more as an afterward than as a self-diagnostic tool.

Now what I do find extremely useful in this book is how it chronicles all of the different types of self-medicating that we go through. Alcohol (the pastor’s choice most of the time), uppers and downers of various sorts, over-the-counter drugs, sex, relationships. We can use almost anything as a narcotic against the creeping darkness and the coming fog. They are all attempts to escape from our lives, or to feel SOMETHING so that we can know we are still human. In that respect it is helpful

Completely lacking in the book, though, is any real interaction with the spiritual element of depression and anxiety. Wurtzel is basically a non-practicing Jew, where religion and spirituality of any sort plays no part in her worldview. That is helpful to recognize at the outset, but that also means that the Christian suffering from depression and anxiety is going to find this book completely lacking in one of the key elements of their suffering. It is a picture of the disease, but it is not a complete picture.

If someone were to ask me today what book could I read to describe what I’ve gone through, I’d probably give them Darkness Visible, because it fits my own experience closer than Wurtzel. However, I would also tell them that there isn’t anything out there that I’ve read which really nails it completely, so they’ll have to wait for the book…

-DMR

book reviews, depression, family

One of Two Books I've Read on Depression: Speaking of Sadness

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Over the last year or more I’ve read a number of books on or about depression in different ways. When I could concentrate enough to read. Two books I read early on I’ve mean to write about for some time. Here is the first one. The second will follow:

Speaking of Sadness
By David A. Karp

Karp is a sociology professor at Boston College. He is not a Christian (neither is the other writer). However, Dr. Karp’s book is profound. He has suffered from depression himself, and so the book is part auto-biographical, part sociology, and part explanation of what is happening to you and how others around you are reacting to it.

Some of the topics he discusses are disconnection, illness as identity, medication, coping, family, and depression’s impact on our society. It was probably the sections on disconnection and illness as identity that were the most useful to me. Depression forces one to withdraw into yourself. You shrink, so that you feel like you are in a deep dark hole and can only barely see out at all. Friends fall by the wayside, family even. Many a divorce has had depression as one of the chief causes. So to understand how and why this disconnection is happening is quite important.

Perhaps equally important is the concept of illness as identity. I remember having a conversation with my wife’s brother once. He said that he hated being called a diabetic. He had diabetes. In his mind, the illness did not define him, and so he wanted to create separation between himself and the illness. That can be done with physical diseases and illnesses to some degree. No one says “I am a flu-er”, you say you have the flu. Even this has it’s limits. Paraplegic. Diabetic. These are but a couple examples of where the illness is incorporated socially into the identity of a person.

But with mental illness it is different. Because depression and mental illness are so invasive, because we can’t seem to separate our minds from ourselves, depression quickly gloms itself on to the identity. You are marked as unclean or not quite right in the head. There is a social stigma that goes along with depression. Are you trustworthy, or will you just crash? Jobs, family, church, all of these areas an more can make depression become a part of you. I am surprised that no one has coined a term like “I am a depressionic” or something to that effect. Karp addresses this phenomenon with a great deal of insight.

Now where is the Gospel in a secular book like this? There isn’t any, directly. He goes through the journey down into the valley and back up again. It is descriptive, with many helpful insights along the way. I would highly recommend this book, for example, to anyone suffering from depression and especially to their family. It is very good for understanding this. What he doesn’t do (and I have yet to find) is a real treatment of the relationship between mental illness and faith. How is it that I can cry, “I trust when dark my road” and yet mentally not believe there is a future for me? Is the mind the sole place for faith, so that if my mind isn’t right, it must mean my faith isn’t right?

God forbid. Faith is a gift, not an achievement. It is a gift that God continues to give, no matter how difficult the circumstances. In fact, the harder it is, the sweeter God’s gift will become. Even if you don’t feel it. Even if you can’t see past the next fifteen minutes. That doesn’t mean God abandons you. It means that he is hidden for a time so that He may reveal Himself more fully to us at the proper time. There is hope. There is a future. There is a Messiah who comes.

-DMR

book reviews, depression, family

One of Two Books I've Read on Depression: Speaking of Sadness

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Over the last year or more I’ve read a number of books on or about depression in different ways. When I could concentrate enough to read. Two books I read early on I’ve mean to write about for some time. Here is the first one. The second will follow:

Speaking of Sadness
By David A. Karp

Karp is a sociology professor at Boston College. He is not a Christian (neither is the other writer). However, Dr. Karp’s book is profound. He has suffered from depression himself, and so the book is part auto-biographical, part sociology, and part explanation of what is happening to you and how others around you are reacting to it.

Some of the topics he discusses are disconnection, illness as identity, medication, coping, family, and depression’s impact on our society. It was probably the sections on disconnection and illness as identity that were the most useful to me. Depression forces one to withdraw into yourself. You shrink, so that you feel like you are in a deep dark hole and can only barely see out at all. Friends fall by the wayside, family even. Many a divorce has had depression as one of the chief causes. So to understand how and why this disconnection is happening is quite important.

Perhaps equally important is the concept of illness as identity. I remember having a conversation with my wife’s brother once. He said that he hated being called a diabetic. He had diabetes. In his mind, the illness did not define him, and so he wanted to create separation between himself and the illness. That can be done with physical diseases and illnesses to some degree. No one says “I am a flu-er”, you say you have the flu. Even this has it’s limits. Paraplegic. Diabetic. These are but a couple examples of where the illness is incorporated socially into the identity of a person.

But with mental illness it is different. Because depression and mental illness are so invasive, because we can’t seem to separate our minds from ourselves, depression quickly gloms itself on to the identity. You are marked as unclean or not quite right in the head. There is a social stigma that goes along with depression. Are you trustworthy, or will you just crash? Jobs, family, church, all of these areas an more can make depression become a part of you. I am surprised that no one has coined a term like “I am a depressionic” or something to that effect. Karp addresses this phenomenon with a great deal of insight.

Now where is the Gospel in a secular book like this? There isn’t any, directly. He goes through the journey down into the valley and back up again. It is descriptive, with many helpful insights along the way. I would highly recommend this book, for example, to anyone suffering from depression and especially to their family. It is very good for understanding this. What he doesn’t do (and I have yet to find) is a real treatment of the relationship between mental illness and faith. How is it that I can cry, “I trust when dark my road” and yet mentally not believe there is a future for me? Is the mind the sole place for faith, so that if my mind isn’t right, it must mean my faith isn’t right?

God forbid. Faith is a gift, not an achievement. It is a gift that God continues to give, no matter how difficult the circumstances. In fact, the harder it is, the sweeter God’s gift will become. Even if you don’t feel it. Even if you can’t see past the next fifteen minutes. That doesn’t mean God abandons you. It means that he is hidden for a time so that He may reveal Himself more fully to us at the proper time. There is hope. There is a future. There is a Messiah who comes.

-DMR

children, depression, Disability, Pastoral Office

On Chase, Preaching and Other Signs of Light

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As I continue on the road to recovery, there have been a couple bright spots that I thought would be worth mentioning here. You never can tell what is really going to be important to you somehow.

Chase
For my children, the mark of my illness and recovery is very simple. Chase. If I can play chase, I must be getting better. If I can’t play chase, then I’m still sick in the head (or something to that effect). Because right now the hardest thing for me to handle is my children, chase sort of represents a reentry into my family’s regular life schedule.

Chase is hard. I know, I know. It’s just running around like a crazy person with a few kids. But for the person suffering from depression, that kind of unwanton abandon, noise, suddon movement and general insanity is way outside of the normal comfort zone. It requires energy, excitement, the ability to say BOO at just the right time, etc.

In other words, just about everything that is difficult, all wrapped up in something that is so easy that most people do it even without thinking. But that is so often the case with depression. Things that you believe should be easy can become difficult on the way to impossible.

I think I’ve played chase once in the last year. This is down from at least once a day, maybe more. The once was last week. If we can move to once a week, that will be a huge step in the right direction

Preaching and Preparation
I’ve been preaching more and more the last couple months. Right now I’m pretty close to every week. Most of the sermons have been reruns, or last-minute throw together jobs. They were not my best were, or if they were, they were my best work from 2-5 years ago.

But last week was the first week that I had “normal” preparation for my sermon. Look at the text early in the week, read patristic and Luther sermons, see if there’s anything worthwhile that’s modern, and then write it down early enough in the week so I have time to edit it. Something like that. This happened last week. I don’t really even know why, it just did. So my Sermon on Sunday was much more relaxed, more “normal” for me. The congregation probably couldn’t tell the difference, but I could. It was a good sign.

Here are some questions for you:
1) What have you found the most difficult thing to come back to doing?
2) What made or is making it the most difficult?
3) What has been the easiest part of your life to return to “normal” and why?
4) What will never be the same?

Food for thought,
-DMR

children, depression, Disability, Pastoral Office

On Chase, Preaching and Other Signs of Light

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As I continue on the road to recovery, there have been a couple bright spots that I thought would be worth mentioning here. You never can tell what is really going to be important to you somehow.

Chase
For my children, the mark of my illness and recovery is very simple. Chase. If I can play chase, I must be getting better. If I can’t play chase, then I’m still sick in the head (or something to that effect). Because right now the hardest thing for me to handle is my children, chase sort of represents a reentry into my family’s regular life schedule.

Chase is hard. I know, I know. It’s just running around like a crazy person with a few kids. But for the person suffering from depression, that kind of unwanton abandon, noise, suddon movement and general insanity is way outside of the normal comfort zone. It requires energy, excitement, the ability to say BOO at just the right time, etc.

In other words, just about everything that is difficult, all wrapped up in something that is so easy that most people do it even without thinking. But that is so often the case with depression. Things that you believe should be easy can become difficult on the way to impossible.

I think I’ve played chase once in the last year. This is down from at least once a day, maybe more. The once was last week. If we can move to once a week, that will be a huge step in the right direction

Preaching and Preparation
I’ve been preaching more and more the last couple months. Right now I’m pretty close to every week. Most of the sermons have been reruns, or last-minute throw together jobs. They were not my best were, or if they were, they were my best work from 2-5 years ago.

But last week was the first week that I had “normal” preparation for my sermon. Look at the text early in the week, read patristic and Luther sermons, see if there’s anything worthwhile that’s modern, and then write it down early enough in the week so I have time to edit it. Something like that. This happened last week. I don’t really even know why, it just did. So my Sermon on Sunday was much more relaxed, more “normal” for me. The congregation probably couldn’t tell the difference, but I could. It was a good sign.

Here are some questions for you:
1) What have you found the most difficult thing to come back to doing?
2) What made or is making it the most difficult?
3) What has been the easiest part of your life to return to “normal” and why?
4) What will never be the same?

Food for thought,
-DMR