The Hazards and Joys of work in Mental Health

Image

One of the riskiest and most challenging aspects of working in mental health is that of suicide.  For those who are depressed, bipolar, and psychotic that risk is very high.  We do everything in our power to prevent such tragedies.

In the last two weeks at work I have witnessed two contrasting stories on the topic.  Firstly, a client committed suicide that was on the caseload of one of the case manager.  This client’s life was very hard, she suffered from extreme highs and lows and she had numerous previous attempts where she had escaped death. The case manager noted that on the weekend that it happened there was a hang-up message from that client.  So close to asking for help.  This was very hard for the case manager and for all those who had worked with the client over the many years.

The second story is one of miraculous grace.  A client of a different case manager told me that one of her clients told her that over the week-end her client had prepared to commit suicide and was ready to do it and at that very moment her phone rang and the client picked it up.  It was his daughter who he had not heard from in 10 years calling to say that she wanted to come and visit him shortly.  This stopped the man in his tracks and he sought out help.

I have never experienced the loss a client by suicide, but I understand that most people who work in mental health do so at some point in their career.  I know that likely I would struggle emotionally and feel guilt and wonder what I could have done.  I know it would be an incredibly painful experience.  Trusting in God, as a loving father, I know he loves that deeply wounded and through the second story see that he does miraculously use us weak human beings for his means of grace in this world.

I was interviewing and listening to a new client the other day as she told me her story of death of all of those close to her, parents who were not available or in jail, and chronic physical problems. I  also read the chart to see also that she had experienced abuse in foster case.  It is so easy to understand how people become so hopeless when they experience life as unhappy and without joy as this woman described.  I just wanted this client to experience the love of Jesus.  The story of the phone call reminds me that God moves in mysterious ways gently and unexpectedly through each person’s life.

My lenten discipline for this season is to endeavour to pray for each client before seeing them and ask that God would give me openness, patience, love and grace.

Advertisements

Happiness :)

On Friday while taking my sick toddler for a walk I bumped into a friend from the neighborhood who I have known from my original days in 2003.  We garden together, have been known to play scrabble, used to drink red wine together (she is now in AA), and have heart to heart discussions.  Eventually after walking down to the nearby beach and back we got to the topic of the purpose of life for us, and for most people.

I said most people want to live the good life, that is be financially secure (ideally earning increasingly more money), have a house, a family, be respected and admired by others, and experience frequent times of fun and happiness (often in the forms of vacations, hobbies, music, entertainment, etc.).  Nonetheless many are unhappy.

While we strive for increasing achievement and “happiness” people around the world are in economic slavery, are raped in wars, die violent deaths.  I think of the case of Tori Stafford- I have read the chilling accounts in Canadian newspapers about how this elementary school aged girl was brutally murdered.  What a horrible way to end such a beautiful life.  With the Kony 2012 campaign I have read how young girls are used as sex slaves in places of war- what kind of short life is that? Likely not one filled with happiness, especially with our culture’s definition of happiness.

When bringing this up in our discussion we also noted that our being or feeling unhappy or despair over the injustice in the world isn’t doing the situation any good.

For years my friend had engaged as an activist against gentrification in our neighborhood, and against war around the world.  It didn’t seem to matter how much frustration and angst she directed towards these issues- it felt as if the world continued in its ways.  What she and I reflected on was that being unhappy and up in arms about a situation and denying ourselves joy in life didn’t advance our causes anymore than those who still managed to speak up for those who needed justice but actually stopped to enjoy life.

Today my friend earns a very modest income but is content with the small things of good she does: mentoring a sponsee, speaking words of encouragement and wisdom to those who are seeking it, spending time in the wilderness up at a cabin, and tending our shared garden.

She reflected that in years past she inherently thought that to live out the gospel it had to hurt (being persecuted for righteousness) and if it didn’t than she wasn’t truly living it out.  Today she allows herself simple joys of life.  She is not chasing after bigger and better but is looking for meaning where she is at.  Bigger or better either in a material/financial realm, but also in the realm of living out Jesus’ teachings.

I, too, often can caught up in trying to live out the gospel so much that it hurts.  And then I stop and think- oh when did I last truly take time to do something that helped me feel joy.  It can be quite hard as a mother of a toddler and a full-time student. Because each moment I have free I have to make choices between school work and relaxation and also being there for others.

However, happiness is not always found in “me” time.  For example, tonight at home group my husband was looking after our little girl and for I truly got to listen to the thoughts of others on what it means to be a child of God from a number of people: an older nurse, and an older lady with mental and physical disabilities and I felt truly humbled and honored both at once.

There is a lot of emphasis on achieving happiness in our culture and in psychology.  There is an idea that to be happy everything in life should be going right (i.e. the above noted recipe for the good life).  However, this definition of happiness does not coincide with a gospel definition of what a life in Christ looks like where we face persecution, and are willing to give up everything for the cross.  But living out life in difficult circumstances (i.e. not being upwardly mobile) does not mean that we must face sure unhappiness or that we should not seek joy and happiness in whatever lot we find ourselves.  I have to remind myself- especially in my predicament of juggling a number of different roles- that I do not have to wait until my life is all “together” to enjoy it but can decide to seek out happiness in the moments and life path that God has given me.

Prayers for helping professionals: St. Theresa of Avila’s “Let Nothing Disturb Thee”

Many years ago I came across this prayer by St. Theresa of Avila, a mystic and nun of the 16th century.

Let nothing disturb thee

Nothing affright thee

All things are passing

God never changeth

Patient endurance

Attaineth to all things

Who God possesseth

In nothing is wanting

Alone God sufficeth

I have recited this prayer in times of stress and anxiety during my life. Let nothing disturb thee herald’s back to countless biblical passages where God’s people are exhorted to fear God, not men ( eg Psalm 56:4: God, whose word I praise, in God I trust; I will not be afraid. What can mortal man do to me?). 

As a social worker working with people experiencing profound mental confusion, crises, and chaos in their lives it is essential to have a firm anchor in God.  Especially when it seems like even the best therapies fail, medications only provide minimal relief, and support is refused.  Ultimately, God is present and I will trust and pray for him to be with this client and myself in this mess we call life.  

It seems so simple, just trust in God, He never changes He’s always there. But we are afraid, we are disturbed by what we see. That is why we get into the work we do- because the state of the world disturbs us and we want to do something about it. 

And it seems at first glance that this prayer provides no recourse, no action to take about that which disturbs us.  Are we left retreat to our personal prayer with God away from these disturbances or claim that these disturbances are perceptions of reality that create suffering (a more Buddhist viewpoint)?

I think this prayer could be interpreted this way but one line challenges me toward engagement: “Patient endurance attaineth all things”.  Patient endurance is an active choice, not a passive observer stance.  It’s like seeing a rushing river that you need to cross and instead of sitting on one side and fretting about it to instead decide to get in up to your waist in rushing water, hold on to whatever you can to get you across and endure the cold water as long as you have to until you reach the other side. 

This is what our life is like, but to patiently endure we must be “possessed” by God.  When we think of the word possessed we often have images of demon possession and exorcism by Catholic priests.  Very rarely do we hear of being possessed by God. Being possessed implies being owned or filled in its entirety. In being possessed by God Saint Theresa rightly says that nothing is wanting.  There is no need if God lives fully in us and through us.

As a social worker this is not easily done.  My place of work, like many of you, does not have its sole purpose in serving and loving God but is there to control and fix situations.  Very rarely can we offer people God’s solace and grace as a salve to their problems.  Mostly we can offer the accepted wisdom of our profession. 

This makes it difficult to be wholly possessed by God.  Maybe St. Theresa had it right in setting up convents and encouraging people to pray and seek God after all. 

How do you manage to keep centred and “possessed” by God as you engage in a secular helping system?

Healing from God and Healing from Therapy

The most visible part of Jesus’ ministry was healing people.  Jesus healed people of long-lasting illnesses, defects from birth, demon possession, raised the dead, but most of all he healed people from their sins.  His physical healing always had the ultimate message that pointed to the redemption of the whole person: body, soul and spirit.  I similarly believe that God has the power to heal today into our broken world- that this is his way of showing signs of his Kingdom for the lost and weary travellers of this earth.

There is a statistic from the World Health Organization that in 2030 depression will be the world’s largest health burden affecting more people than any other disease.

http://news.bbc.co.uk/2/hi/8230549.stm

If this will be the biggest disease burden of this world, where is Jesus and how is he working in the world for the healing of this condition?

We have often looked to Jesus to only heal physical symptoms, and are hesitant to ask God to heal mental health conditions, like depression.  This is in part because the church has viewed mental illness with stigma and often blames the individual, or family.  It is also because people, like myself, have prayed for the healing of people’s minds and addictions to no avail.  It is hard to find many stories of God’s miraculous healing of depression or schizophrenia.  Perhaps we lack faith, perhaps we do not fully understand the spiritual-socio-biological interactions of depression.

In fact, this is probably one of the main reasons that I decided to get training in social work and counselling.  I wanted more skills and tools to support, love, and promote the healing of people around me who struggled with trauma, addiction, and mental illness.  In our little church of about 20 or so people on any given Sunday I would guess that about 50% of people in the room have a diagnosed mental health condition (including substance abuse).  Some are on the paths to healing by slowly regaining independence and faith in God, while others feel like they haven’t received much relief from God or from therapy or medications.

I wish God would simply heal people, that we wouldn’t need psychotherapy or pharmaceuticals for mental health issues. I also wish that we did not need anti-retrovirals or chemotherapy for HIV/AIDS and cancer, but we do.

As a Christian therapist I have read the scientific research on mental illness.  Most medications address symptoms, rarely do they provide a cure and its’ success varies widely depending on the condition and the medication.  Similarly, psychotherapy fails many people and is not the cure-all for mental health issues although some forms of psychotherapy can provide lasting and improving relief from symptoms.  Interestingly enough, some people do not develop long-term symptoms and may have spontaneous remission or “natural” recovery with limited or no pharmaceutical or psychological interventions.

Prayer does not always cure.  The church regularly fails to care and love those struggling in their midst.  We fail to be a family of faith that treats each person as an equally beloved child of God.

Although the role of the therapist is not explicitly a biblical one, it will become increasingly important as the mental illness becomes more prevalent and recognized in our world.  Being a Christian therapist allows one to offer the most effective treatment available, while also believing in God’s ability to take care of a person in a way that reaches beyond what our limited understanding has discovered. Being intentionally open to the Holy Spirit, while using sound therapeutic judgement and evidence-based practices are ways of operating ethically and faithfully as a servant of Christ working within a secular medical system.

What are your experiences with mental illness and Christian faith/the church?

If you are a Christian therapist, how have you seen God work or what success have you seen within therapy?  What has surprised you?

What tension do you see between healing from God and healing from therapy?

Through the eyes of a Friend

I want to tell you about the most interesting thing that happened in therapy with a client. I was working with a man who has experienced significant trauma in his life and we were doing a safe place visualization where he imagines a safe place and I ask him questions to enrich the visualization.

One of the questions I asked was “who is there with you”. He answered a friend, a childhood friend. This man reports having no friends and no close family, and no social support in his life but was able to go back to his childhood and find a loving and kind friend. When I asked him about this friend after the visualization I found out that he and his childhood friend both had a similar name.

What a discovery! Inside of himself was not just a friend, but a kinder, gentler, more accepting part of himself an alter ego of sorts, a companion to the blaming, negative “self” that has crept in to dominate his vision of himself accusing  of failure day in and day out. It is incredible what an experience with a good friend can do for a person, even if the friendship is no longer present. It is similar to the experience of the therapeutic relationship; it gives a person a chance to build an alternate reality than they are accustomed one that is trustworthy, and stable that can disrupt older patterns of thinking that have gotten a person or family stuck.

It reminds me of my and my friends personal journey with people in our neighborhood who struggle with addiction and have had abusive childhoods.  For many years we plod along, not perfectly, but trying our best to be loving friends to those who are not always easily befriended, and who need a lot more than we can give.  It can be easy to dismiss these relationships as of such a small value in their overall healing journey.

Afterall, our love for one another pales in comparison to the amazing love and forgiveness that God offers to each of us.  But for some reason or another God chose us to live in relationship with one another and be the bearers of His love for the world to each other.  It would seem a lot more effective that he could appear in visions with bright light and angels announcing his love to each person, but instead he works in mysterious, gentle, and sometimes quiet ways through our broken selves.

Let us find encouragement that through the loving gaze of a friend this man could feel love and acceptance that he would not otherwise feel toward himself, and that our commitment to love can go a long way.