What do you say to people who ask if you’ll eventually stop taking medication?
I say to people that they don’t expect a diabetic to stop taking insulin, or someone with a heart condition to stop taking blood thinners. I have a chronic, lifetime disease and the only responsible thing for me to do is stick with my medications.
People wonder about medications’ long-term effects on the brain. I explain that while the medications’ effects appear to be reversible as soon as you stop taking them, the long-term effects of having repeated depressive episodes appear to be absolutely dire. There is lesioning of the hippocampus, and brain cells die. And this is in addition to the havoc that such repeated episodes cause in your daily life.
Imagine you have heart disease. You’re prescribed medication, you do better for a while, so you stop the meds. Then you have another heart attack, so you go back on the medication to get better. Twelve heart attacks later, what kind of shape are you in? It’s obviously crazy. If you have recurrent depression, you are not being “courageous” or “genuine” to go off your medication. You’re being foolish.
Can you explain the importance of balancing therapy and medication?
Different treatments work for different people, and I am open to the endless possibilities out there. But for most people, a combination of medication and therapy is the surest-fire way to handle depression.
The medication alleviates the worst symptoms and lets you function again. It makes life and the world bearable. But once you have emerged from the horror, you need to learn skills for managing the illness. You need to understand where it comes from. You need to make your peace with the idea that you cannot be fully yourself without the use of medications or other support structures.
And you need someone capable who can keep an eye on you. Ideally, you also need to understand the structure of your own personality and who you are; this gives you a feeling of peace and allows you to get through a difficult time with dignity.
By his mid-twenties, Solomon established himself as a multi-disciplinary wunderkind, earning international accolades for his work as a novelist, journalist and historian. After the death of his mother, the then 31 year old Solomon descended into a major depression, rendering him unable to work or even care for himself. He was helped by a combination of medications and talk therapy. This experience formed the bedrock for his National Book Award-winning “Noonday Demon: An Atlas of Depression”, a tour de force examining the disorder in personal, cultural, and scientific terms.
From an article in Christianity Today, February 9, 1998
“The only army that shoots its wounded is the Christian army,” said the speaker, a psychologist who had just returned from an overseas ministry trip among missionaries. He summed up the philosophy of the group he worked with as:
1. We don’t have emotional problems. If any emotional difficulties appear to arise, simply deny having them.
2. If we fail to achieve this first ideal and can’t ignore a problem, strive to keep it from family members and never breathe a word of it outside the family.
3. If both of the first two steps fail, we still don’t seek professional help.
I have been a Christian for 50 years, a physician for 29, and a psychiatrist for 15. Over this time I have observed these same attitudes throughout the church—among lay leaders, pastors, priests, charismatics, fundamentalists, and evangelicals alike. I have also found that many not only deny their problems but are intolerant of those with emotional difficulties.
Many judge that others’ emotional problems are the direct result of personal sin. This is a harmful view. At any one time, up to 15 percent of our population is experiencing significant emotional problems. For them our churches need to be sanctuaries of healing, not places where they must hide their wounds.
THE EMOTIONAL-HEALTH GOSPEL
Several years ago my daughter was battling leukemia. While lying in bed in the hospital, she received a letter, which read in part:
Dear Susan, You do not know me personally, but I have seen you in church many times….I have interceded on your behalf and I know the Lord is going to heal you if you just let Him. Do not let Satan steal your life—do not let religious tradition rob you of what Jesus did on the cross—by His stripes we were healed.
The theology behind this letter reminded me of a bumper sticker I once saw: “Health and Prosperity: Your Divine Right.” The letter writer had bought into a “healing in the atonement” theology that most mainstream evangelicals reject.
According to this traditional faith-healing perspective, Christ’s atonement provides healing for the body and mind just as it offers forgiveness of sins for the soul. The writer meant well, but the letter created tremendous turmoil for my daughter. While evangelicals have largely rejected “health and wealth” preaching—that faithful Christians will always prosper physically and financially—many hold to an insidious variation of that prosperity gospel. I call it the “emotional-health gospel.”
The emotional-health gospel assumes that if you have repented of your sins, prayed correctly, and spent adequate time in God’s Word, you will have a sound mind and be free of emotional problems.
Usually the theology behind the emotional-health gospel does not go so far as to locate emotional healing in the Atonement (though some do) but rather to redefine mental illnesses as “spiritual” or as character problems, which the church or the process of sanctification can handle on its own. The problem is, this is a false gospel, one that needlessly adds to the suffering of those already in turmoil.
This prejudice against those with emotional problems can be seen in churches across the nation on any Sunday morning. We pray publicly for the parishioner with cancer or a heart attack or pneumonia. But rarely will we pray publicly for Mary with severe depression, Charles with incapacitating panic attacks, or the minister’s son with schizophrenia. Our silence subtly conveys that these are not acceptable illnesses for Christians to have.
The emotional-health gospel is also communicated by some of our most listened-to leaders. I heard one national speaker make the point that “At the cross you can be made whole. Isaiah said that ‘through his stripes we are healed’ … not of physical suffering, which one day we will experience; we are healed of emotional and spiritual suffering at the cross of Jesus Christ.” In other words, a victorious Christian will be emotionally healthy. This so-called full gospel, which proclaims that healing of the body and mind is provided for all in the Atonement, casts a cruel judgment on the mentally ill.
Two authors widely read in evangelical circles, John MacArthur and Dave Hunt, also propagate views that, while sincerely held, I fear lead us to shoot our wounded. In his book “Beyond Seduction”, Hunt writes, “The average Christian is not even aware that to consult a psychotherapist is much the same as turning oneself over to the priest of any other rival religion,” and, “There is no such thing as a mental illness; it is either a physical problem in the brain (such as a chemical imbalance or nutritional deficiency) or it is a moral or spiritual problem.”
MacArthur, in “Our Sufficiency in Christ”, presents the thesis that “As Christians, we find complete sufficiency in Christ and his provisions for our needs.” While I agree with his abstract principle, I disagree with how he narrows what are the proper “provisions.” A large portion of the book strongly criticizes psychotherapy as one of the “deadly influences that undermine your spiritual life.” He denounces “so-called Christian psychologists and psychiatrists who testified that the Bible alone does not contain sufficient help to meet people’s deepest personal and emotional needs,” and he asserts, “There is no such thing as a ‘psychological problem’ unrelated to spiritual or physical causes.
God supplies divine resources sufficient to meet all those needs completely.” Physically caused emotional problems, he adds, are rare, and referring to those who seek psychological help, he concludes: “Scripture hasn’t failed them—they’ve failed Scripture.”
A PLACE FOR PROFESSIONALS
When adherents of the emotional-health gospel say that every human problem is spiritual at root, they are undeniably right. Just as Adam’s fall in the garden was spiritual in nature, so in a very true sense the answer to every human problem—whether a broken leg or a burdened heart—is to be found in the redeeming work of Christ on the cross. The disease and corruption process set into motion by the Fall affected not only our physical bodies but our emotions as well, and we are just beginning to comprehend the many ways our bodies and minds have been affected by original sin and our fallen nature. Yet the issue is not whether our emotional problems are spiritual or not—all are, at some level—but how best to treat people experiencing these problems.
Many followers of the emotional-health gospel make the point that the church is, or at least should be, the expert in spiritual counseling, and I agree. Appropriate spiritual counseling will resolve issues such as salvation, forgiveness, personal morality, God’s will, the scriptural perspective on divorce, and more. It can also help some emotional difficulties. But many emotional or mental illnesses require more than a church support network can offer.
I know it sounds unscriptural to say that some individuals need more than the church can offer—but if my car needs the transmission replaced, do I expect the church to do it? Or if I break my leg, do I consult my pastor about it? For some reason, when it comes to emotional needs, we think the church should be able to meet them all. It can’t, and it isn’t supposed to.
This is why the emotional-health gospel can do so much harm. People who need help are prevented from seeking it and often made to feel shame for having the problem. Thankfully, more and more people in the Christian community are beginning to realize that some people need this extra help. If professionals and church leaders can recognize the value of each other’s roles, we will make progress in helping the wounded. Forty percent of all individuals who need emotional help seek it first from the church, and some of these will need to be referred to mental-health professionals.
Church leaders should get to know Christian therapists in their communities so they can knowledgeably refer people with persistent emotional problems.
A person who is paranoid has fears, such as being watched, harmed or poisoned. He or she does not trust others and is suspicious that others are “out to get” him or her.
It is normal to wonder if people are talking about you when you hear them whispering as you walk into a room. These thoughts are usually passed off and not dwelled upon for most people.
A person who is paranoid, however, does dwells upon suspicious thoughts. He or she goes out of their way to prove their suspicions even though no evidence exists to confirm their thoughts. It’s very hard to reason or speak what is real. Paranoia is usually found in small degrees in almost every mental illness.
Use and/or withdrawal of certain drugs, such as marijuana, crack cocaine and angel dust (PCP)
Deafness or problems with hearing
Illnesses that affect the central nervous system, such as Alzheimer’s disease or other dementias, a stroke, a brain tumor
Mental illnesses, such as bipolar disorder or schizophrenia
Paranoid personality disorder, (PPD)
How to Recognize Paranoia
A person with paranoia may also:
Appear cold and aloof
Be withdrawn and anxious in social situations
Act stubborn and combative
Appear “on guard” at all times, out of fear of being harmed
A paranoid person also:
Complains about his or her health and often feels vulnerable and inferior to others
Holds grudges easily
Displays bitterness and resentment toward others
May be easily drawn into religious cults or other groups with strict beliefs
Can have delusions of being persecuted
Treatment for paranoia depends on its cause. If it is a symptom of another condition, treatment for the condition will often take care of or lessen the paranoia. Paranoid personality disorder is treated with counseling, support therapy and often with medication. Treatment for this disorder is not easy, though, due to the nature of paranoia. Persons who are paranoid often do not trust others including doctors, therapists or family members trying to help them get treatment. It is likely that you will need to intervene, patiently and gently. Paranoia treatment requires a huge commitment.
What You Can Do for a Friend or Relative
The most important thing you can do is to encourage your friend or relative to get professional help. Be aware that you may need to make the initial appointment with a professional. You may also need to take them to the appointment and stay with them. Be supportive. Paranoia requires patience, understanding, love and encouragement of the person’s loved ones and friends.
Be aware of the types of medication your friend or relative takes and when they should take it. You should also alert their physician or psychiatrist to any side effects that you notice when they do or do not take their medication. If I may, I would suggest a film for you to watch, “A Beautiful Mind“. This may give you insight into what you are dealing with.
The Psalms are a classical example of self encouragement. The writer sometimes fell in to some moments of depression and he would write encouraging words to uplift his spirit. Today these have become encouragement verses or scriptures for us to emulate. Read Psalm 42. It is somewhat an unusual portion of scripture, in as the writer addresses his/her own soul. That alone makes it unique. And if we think it out, we become aware of an awesome truth.
“I suggest that the main trouble in this whole matter of spiritual depression in a sense is this, that we allow our self to talk to us instead of talking to our self . . . Take those thoughts that come to you the moment you wake up in the morning. You have not originated them, but they start talking to you, they bring back the problems of yesterday, etc. Somebody is talking. Who is talking to you? Your self is talking to you. Now this man’s treatment was this; instead of allowing this self to talk to him, he starts talking to himself. ‘Why art thou cast down, O my soul?‘ he asks. His soul had been depressing him, crushing him. So he stands up and says: ‘Self, listen for moment, I will speak to you.’ Do you know what I mean? If you do not, you have had but little experience . . . We must stand up as this man did and say: ‘Why are you cast down? Why are you disquieted within me?’ . . . instead of listening placidly to him and allowing him to drag you down and depress you. For that is what he will always do if you allow him to be in control.”
D. M. Lloyd-Jones, Spiritual Depression: Its Causes and Cure (Grand Rapids: Eerdmans Publishing Co., 1982), pp. 20,21.
When I allow myself to indulge in anger, impatience, worry, pride, or spite, I provide an entrance for Satan to enter my life and run rampant through my mind. He doesn’t have to scheme, plan or deceive me. He can walk right in and begin chasing my self-centered emotions all over the place. My impatience breeds irritation; irritation– anger. Anger chases bitterness, and bitterness– unkindness. Satan just keeps bringing more and more situations and circumstances in my life that wreak havoc with fruit of the spirit. In my weakened state, my heart is left vulnerable to more and more assaults.
“He who has no rule over his own spirit is like a city that is broken down and without walls.”
The Bible teaches us that we are responsible for our behavior. As believers we simply do not have the option to allow depressive self-talk to go on unedited and unchallenged. If we think about it, as we are depressives and the mentally ill, we must take a stand! This idea can help us through much anguish of soul. The concept of ‘kindling’ a depressive bout can lead us to ‘flare up,’ and get out-of-control. Remember, depression is both physical, emotional, and spiritual issue.
“Accepting the reality of our broken, flawed lives is the beginning of spirituality not because the spiritual life will remove our flaws but because we let go of seeking perfection and, instead, seek God, the one who is present in the tangledness of our lives.“
— Michael Yaconelli
The principle is sound. We let go of our flaws, and make no effort to redeem them. Sounds easy. Although I feel no qualms in doing so, I still wonder. Can He forgive so much, and so many brazen sins?
We can so easily turn on ourselves (at least that’s the tendency) and find accusation. We become our worst enemy, we desperately carry our guilt like some overloaded and heavy pack all throughout our broken lives.
We must finally realize we can no longer seek perfection (or its facsimile) by our conduct. Things have gotten far beyond this. We are rascals and ragamuffins– and are likely to remain so. Unless God intervenes decisively.
But love has a way of loosening our rigorous thinking, like a rusted nut on some corroded metal bolt. He wrenches us, and wants to forgive us of everything. He has decided to love us. You must respond to find his forgiveness. Plain and simple.
Instead of seeking perfection, we should be really seeking God. I suppose this can be daunting. But God is comfortable in our difficulties. He rules over our personal confusion. We come with less then zero. He gives us everything.
We can do nothing but accept. His grace. Grace moves us beyond our personal tragedy. Finally accepting we can do nothing, he does everything.. And where does this leave us?
Our striving for a final acceptance comes down to this: He rules over all our ‘issues,’ and we’re constantly made aware of this excessively extravagant grace. We are rich, only because he has made it so.
There is no one else who can make us worthy. There is no one else who can connect with our sin and then at the same time make us holy in his eyes. There is only God.
Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.
By John Piper, originally published September 12, 2008
The following is an edited transcript of the audio.
Can we learn something from Job’s friends about how to help the hurting?
Absolutely. Those first seven days were their golden hour. If they had stopped there they would have been heroes, I think, because they would have shown compassion and patience. And that’s what we should learn.
When you walk into a horrific calamity you should be really slow to speak and quick to listen. You should be quick to cry, quick to hold, and quick to meet needs, bring meals, and wait upon the Lord. The theological wrestling comes later, probably. It’s different with different people.
But I think the lesson we learn from the progress of the book of Job is that while those three friends—Eliphaz, Bildad, and Zophar—were sitting in dust and ashes, aching with their friend Job, he was helped by them. And many people are helped just by the loving presence of another.
I don’t think this nullifies the importance of truth. Let me give you an example.
I’m a colleague here with Tom Steller, who has been with me for 24 years. And Tom and I have sometimes said to each other, “It would be great to stay together long enough to die together, Tom.” And depending upon which one of us comes to visit the other in the hospital at our dying moment, we know, because of 24 or (perhaps by then) 54 years together, we don’t have to say a word. It’s all been said.
We have a common theology. Neither of us will have to preach to the other in order to fix their ideas. We will all know that God reigns, God is good, God is loving, and God is wise. We’re perplexed, but you don’t need to preach. Let’s just take each other’s hands and pray and fight this fight of faith together.
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These are a list of things that people who have difficulties when they become high or manic have found helpful:
Try to get some sleep. Going without sleep has been shown to cause manic states and make them last longer.
Eat well. Don’t go without food or eat high energy food. Eat slowly.
Use relaxation techniques. Quiet prayer works well right now.
Stay in bed even though you feel compelled to do lots of things.
Don’t act on your ideas. In a few days time you may see things completely differently. Emailing friends now is dangerous. (I know).
Don’t buy anything expensive. Some people have found it helpful to give their credit cards/check book to friends. (I tried to buy a 7 foot potted tree in London, UK once, because it was lonely.)
Use medication, herbal remedies, or other things that slow you down and/or help you sleep. Think “speed bumps”.
Take relaxing (rather than high energy) exercise e.g. walking, swimming. This is a must-do.
Make a plan for each day and keep to it. Don’t plan to do too much.
Try to do things slowly rather than quickly. Talk and walk consciously slower than you feel driven to.
Challenge any grandiose ideas you might have about yourself. You must do this!
Reduce any pressures or stresses on you.
Cut out stimulants e.g. coffee, sugar, chocolate, fizzy drinks, alcohol. Some anti-depressants (e.g. the SSRIs like Prozac) can have stimulant-like effects – discuss this with your doctor and consider stopping them.
It may be helpful for you to make a plan about what to do before you get really elevated. You know yourself best, so build as many things into the plan that you feel will help you not do things you may later regret. It may be helpful to draw up a plan, and a list of ‘warning signs’, with a trusted friend or mental health professional at a time when you are not ‘high’, but that can be put into place as you or others notice your warning signs.
Some people believe that ‘getting manic’ is a response to not thinking about or facing things that might be quite frightening or depressing. It might be helpful to ‘get connected’ to such things, by talking and thinking about your life and some of the root causes of some unhappiness in your life. You could do this with a trusted friend or mental health professional.