Suffering and Trauma

A few days ago I picked up Trauma and Recovery by Judith Herman a book that has been recommended by various people I’ve met in the field of trauma.  Herman uses a feminist narrative to understand the history of trauma, responses to trauma, and recovery.  Right now I’m entrenched into the gory details of human suffering.  As I read the descriptives of what people have suffered in concentration camps, through rape, kidnapping, and child abuse I begin to feel that I cannot bear taking in any more stories of such pain.  It is at these moments that I feel the weight of working in the profession that I do.

In reading this book and hearing the reams of horrible nightmare-like events that people survive I’m drawn back to Job.  How in the world did he manage to cling to his faith in God during that time?  Herman in her book claims that only the smallest minority can survive intense war/kidnapping/abuse without experiencing symptoms of trauma.  She develops a hypothesis that for all there is a breaking point although that is different for some than others.

I was speaking to a colleague today and I challenged her to find a client with a significant persistent mental health issue who has not suffered family neglect/abuse or some sort of trauma inflicted by others.

It is interesting that the line of treatment for mental health issues is cognitive behavioral therapy something which is aimed at understanding and restructuring thoughts and negative core beliefs, but does not centre on pain and suffering as a central part of its framework.  However, for the severely traumatized/mentally ill most clinicians likely agree that this is rarely adequate or enough.  Many cases we file away as hopeless, at least within the bounds of a brief therapy/managed care setting.

I tend to hope that even a short-term therapy interaction that can provide a person a sense of safety, a holding place to process their emotions and begin to understand their thoughts and feelings could be helpful.  I believe this because I have faith that most of the change in people’s life happens outside of the therapy session, through the community, extended family, and social engagement.  However this change may not be initiated or engaged when a person continues to be captive to the negative and false beliefs about themselves that were necessitated by an oppressor (especially one who they loved).  How can we give the fit of beginning on the path to change and healing without falling off that path all together?

For many we do not do enough and some will leave the opposite feeling disappointed and abandonned again, by us as mental health professionals.

Some, however, I hope (with God’s grace and care) are carried onward by a significant experience of care and understanding in therapy.  For this these individual are able to begin to acknowledge their pain, sit with it, process it, and then through re-imagine the world based on new experiences  and then regain a realistic trust in the world and see themselves as worthy and lovable human beings.

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What is the purpose of church?

Many people who have grown up in the church have questioned the need and relevance for the formal gathered “institutional” church. People wonder whether all the organization and jargon just further distances people from God.  Church attendance inaccurately pretends to visually allow people to measure one another’s level of faithfulness to God and that is disconcerting.  We often do not agree with the message being spoken, and are bored or uninterested in church services.  Or even worse, we realize that we come to be entertained but have no real relationships with the fellow people in the pews. Churches seem stuck in their ways and in many ways embody oppression in ways that are quite embarrassing.  

I’ve attended numerous different denominations, both high and low, liberal and conversavative. I’ve had the opportunity to visit churches around the world and pray with others in many different languages.

I’ll be upfront: I’m a proponent of “church” but am pretty loose in what that means.

Jesus says where two or three are gathered in his name, there Jesus is with us (Matthew 18:20).  We do not need a large crowd, a specific structure, but a gathering of those who believe to be with Jesus.

Similarly Paul encourages the believers not to stop meeting with each other (Hebrews 10:24-25).  This indicates to me that it is important to regularly and consistently gather one another in order to spur one another to live obedient lives and love each other and those around us.

Culturally, the temple life played a significant role in providing meaning and religious teaching in the lives of Jews in Jesus’ time.  We know that Peter and Paul (and Jesus) likely still continued to go to temple as there are numerous stories where healings take place in such contexts. 

In our culture too, the people will continue to look to the visible church when they are searching and wondering about Jesus.  Having different expressions of the church, but being visibly gathered says something to the culture around us, hopefully something good if we are truly living out the gospel in love.

Right now, I write this post as my little church is dwindling small and I am beginning to feel discouraged.  We don’t have amazing musicians and well-known preachers. I have to remember why we gather together. 

My answer is to be a witness to Jesus by loving each other.  My little church is made up of outcasts and sinners.  On any given Sunday I count 50% of the people who attend have a mental illness or addiction.  This is not glamorous, but it does mean that we are welcoming those to the table that will not invite us back to dinner themselves (Luke 14).  This takes lots of practice in loving and a commitment to people, week after week.  That is church to me.

An Honest Look at Depression

I co-facilitate a depression group with a counsellor/social worker about 20 years my senior who has thought deeply on the the topic of depression.  He often challenges clients with the statement 

We “follow” a widely used psycho-educational CBT-based manualized program .  We start light on the topics of : goal-planning, stress, diet, exercise, and nutrition.  We encourage people to make SMART goals with their small successes as stepping stones to easing out of depression.  The manual also looks at social engagement, fun activities, assertiveness, and also negative thinking patterns.  Basically it looks at the whole of a person’s life that is affected by depression and works to gain understanding into how altering behavior and thinking, even in small ways, can improve mood and decrease depression.  

This is all fine and wonderful.  However this manual only dedicates about one session (if that) on core beliefs.  My co-facilitator thinks that depression is at its core about a couple main themes.

1. Hopelessness  

2. Worthlessness and

2. Isolation

 

Firstly, based on his model he sees a big problem with targeting the externals (social activities, exercise, etc.) as a real effective change agent for depression.  

As a person with depression at their core thinks they are worthless, hopeless and deserve to be alone even small successes of changing diet or exercise likely do not help in the long-term.  For example, someone starts to do well walking everyday, but still feels depressed.  We say “Fred great work, look you accomplished what you haven’t been able to do in 10 years”.  He then thinks “Oh God, I feel even worse, I must be really depressed, I should be feeling happy but I can’t even get better when I follow this program”.  When we solely focus on the externals of someone’s life, even their negative thinking about events or triggers, the core beliefs may persist.  

This is of course classic CBT, but often we as therapist may stay on the surface for some time or look solely at the environment or triggers or be quick to offer realistic core beliefs that a client “should” instead of staying and delving into the darker beliefs that sustain an individual’s depression and allowing the person themselves to acknowledge and desire alternative ways of seeing themselves.

My colleague insists that to begin to effectively treat depression we must start to acknowledge the true thoughts and beliefs that are plaguing the person.  For example, an honest statement to really get going on therapy would be : “I’m making all of these goals and getting out and being social, but I still don’t feel good, I really believe that I should be alone, that I don’t deserve to have friends”.  In a trusting therapeutic context we process that and then work forward and life improvements.

One thing that he says is that “Nobody wants to be here” [in therapy].  Most of us therapists find it hard to believe.  In saying this he means that the nature of the depression, while they are still depressed is that honestly most people find being in therapy further confirms their worthlessness.

Of course I like to think that people both do not want to be in therapy and also want to because the therapeutic relationship itself is an avenue of hope as they learn to act out and learn positive regard and new ways of relating that bring life instead of darkness and depression.  That having someone caring, yet challenging in their life is something people find incredibly difficulty but also crave.

Clients with depression carry a heavy burden, many have suffered a large part of their life.  They are experts in understanding themselves; what we can bring is empathy, acknowledgement of the depth of their pain and darkness, faithfulness, and a keen balance of questions and encouragement that can help them find their way to a more realistic view of themselves and the world.

 

What are your experiences with therapy for depression?

What has worked? What hasn’t?