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Learning to help

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This is a question I get a lot. Often from wives, fellow pastors, circuit counselors, even an occasional district president. What do you do with someone who suffers from depression? It sounds like a slightly ridiculous question, but it is a hugely important one. If we are going to be the Body of Christ to those who suffer, then that service of love must take on flesh and blood. We have to think through what we can actually do, and perhaps even more importantly, we have to recognize what we cannot do.

Let’s start with #2, and work our way back to #1. What can’t you do to help someone who suffers from depression?

  1. You can’t fix it. There is no pill, no prayer, no magical words you can say that are simply going to make things better. One of the greatest dangers that those of use who love those who suffer face is the mistaken notion that I can control the situation. I am not God, to kill and make alive. I cannot control the medication, their soul, their psyche, or really much of anything else when it comes to someone else. By recognizing this simple reality, it frees you to not be God and then to be His child.
  2. There is no one solution. God has created us in wonderful, mysterious ways. The intersection of the body, mind and spirit is far beyond our understanding. In the same way, a disease like clinical depression has many facets to it. There is a clear spiritual dimension that requires serious pastoral care (we’ll get to that more). There is a clear physiological dimension that requires real medical care. And there is a clear psychological element that also requires the expertise and care of a counselor, psychologist, or someone trained in the healing of the mind. By presenting the problem as one dimensional, all we really end up doing is creating more layers of guilt and shame when things continue to unravel. Do we really need that? I think not.
  3. You can’t simply blame them. I know it’s tempting. I know that the clinically depressed person is nearly impossible to live with. If it’s any consolation, it is probably even harder for them to live with themselves. They are sinners, and so there is sin involved. But they are also trapped by their own failures, and the interaction of their own failings with this disease means that they need mercy and love and care, not guilt. This, by the way, is true for all of us, not simply the clinically depressed.

That’s what we can’t do. Here is what you can do:

  1. Pray. This is not simply pious talk. The clinically depressed have a terrible time with prayer. You can pray for them because they may not be able to pray for themselves. Pray for faith, strength, wisdom, and pray that the right people would enter into their lives so that healing may begin.
  2. Serve. One of the hardest things to do when dealing with the depressed is to serve them. Our Lord gives us the picture of humble service on the night when He was betrayed. The service which we render may mean really mundane things, like a meal or watching children for a while or a night to themselves. It probably isn’t pointing out to them what’s wrong. Simply demonstrating that you love them in word or deed really goes a long way.
  3. Intercede. What I mean by this is that very often, the clinically depressed are not able to advocate for themselves. This may involve insurance companies, church, work, or even with family. It could be that what they need most is someone who is willing to sit with them and help them to actually make sense of some element of care that just escapes them. I’ll write more on this soon.

These are just a few thoughts that come to mind. How about you? What have you found that is the most helpful or unhelpful?

-DMR

book

Checking out NAMI, MHM and how they view faith

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I recently had an episcopal priest recommend NAMI and Mental Health Ministries to me, and specifically to look into the following document they have available:

Mental Illness and Families of Faith: How Congregations Can Respond
Resource/Study Guide for Clergy and Communities of Faith

I haven’t read it list, but I’m putting it in my reading list for soon.  Is anyone familiar with this organization?  How would their goals line up with faithful Lutheranism?

-DMR

depression

Melancholy is the devil's bath

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melancholy.jpg

Melancholia balneum diaboli

I have been doing a peer review of a fantastic book by a 17th century theologian named Herberger. I pray that this volume will be published by CPH or someone else within the next year, because it is packed full of wisdom from God’s Word. Nearly every page seems to be full of gems like this one:

To have a sick heart is the greatest trouble on earth. Many may have not a single sick soul in the house, but in the breast there is a sickbed in which an ailing heart lies, letting out great groans. There laughter is stifled. Hence St. Paul calls it “Satan’s messenger”; for “the devil truly avails himself of the melancholy of the pious.” Melancholia balneum diaboli. He climbs on top of what is cast down, and pours out more onto what is already soaked, just like a true sadist. He turns a little infraction into a great, terrifying sin unto death. He has to do everything to the extreme: out of a speck of dust floating in the sunbeam he makes a huge mountain. He sharpens all thoughts into daggers and spits for the heart, making man to despair of bringing out the best of the situation.

We have certainly reflected long and hard here the relationship between physical depression and spiritual distress. Here Herberger seems to have an understanding of this hundreds of years ago. Depression is the playground or bath in which the devil loves to work. Depression turns us inward, makes us overfocus and blow every little setback so far out of proportion that is hardly recognizable. Depression can easily lead us to despair even of our very lives.

But Christ calls us back from peering over the edge. There is a sickness, but it is not unto death. There are problems, but they can be overcome. No matter what the difficulty you face, whether it is personal, financial, medical or spiritual, Christ is with you. He will see you through it.

Thanks, Doctor Herberger. Your words bring into focus how God can use these things to our benefit. We pray with you:

“O my dear Lord Jesus Christ, who said: ‘Pray, and it shall be given you; seek, and you shall find; knock, and it shall be opened unto you’; by virtue of this Your promise, O Lord, grant to me who pray not for gold or silver, but for a strong, firm faith. Let me find, for I seek not pleasure or worldly joy, but comfort and new life through Your blessed, comforting, wholesome word. Open unto me who knock. Nothing do I desire that the world counts great and high, for by such I am not made a hair’s breadth better before You: Instead, give me Your Holy Spirit to illumine my heart, strengthen and comfort me in my anguish and distress, preserve me in true faith and trust in Your grace until my end. Amen.”

children, depression

His name is Emannuel

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This has been a more eventful Advent and Christmastide than usual in the Peperkorn household. As you may have heard, we were (surprised and) overjoyed at the end of October to discover that Kathryn was pregnant. Our joy was turned to sorrow in mid-December as we learned that she had lost the baby.

It’s really hard to even describe this experience. The span of emotions, the sorrow, guilt, anger, frustration, and strange relief all rush together in one big glob of pain that is almost overwhelming. Miscarriages are so odd in our culture, because there is a sense where A) We shouldn’t talk about it; B) If we do talk about it, to try and minimize it; or C) To OVER engage the whole process, as though this is an opportunity to make some religious or political statement about abortion.

Kathryn and I lost a child (Nadia) four years ago, and so I thought this would ease the pain, or at least our understanding of the pain. But that is just not the case. Each grief is its own. Just as each child is different, so the loss of each child is different, even a child only eight weeks old.

Part of Kathryn’s fear I think is that I will fall into another depression. Nadia’s death was the beginning of a long downward slope for me last time, so that’s a pretty reasonable fear on her part. It is so easy in this life to take one tragic event and allow it to escalate into a holocaust.

But it does not have to be so. Past history does not guarantee future events. While it may be a decent predictor sometimes, it can also serve to create self-fulfilling prophecies. There are a lot of things different from four years ago for us:

1. We are much more aware of God’s mercy in taking are of our family. He has seen us through this and more.

2. We are both more aware of our medical needs, moods, and the “signs” when things aren’t going quite right.

3. Our support group(s) of family, friends, church, etc., has been wonderful. They were all good last time, too, but I think everyone is a little more aware of what’s happening now.

So be at peace, friends! The Lord is with you. I will be back in the swing of writing again soon.

-DMR

anfechtung, depression, Lutheran, S.A.D.

Advent: The Most Lutheran of Seasons

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Lutherans are often portrayed as being a “Lent” sort of people. Somber, slow chorales. A generally dark disposition. Anyone who looks too cheerful and happy must be a charismatic or something. Yet, if anyone is too sad or (ahem) depressed, they must not know Jesus loves them. Sometimes it’s hard being Lutheran

Yet in comes the season of Advent! Advent, which it’s joyous and hopeful hymnody, yet penitential character, seems to me to reflect perfectly the paradox which is Lutheranism, and dare I say Christianity itself. We receive the Gifts now, but they are not here in their fulness. We look for the coming of the Savior, but we do so with both repentance and joy. Our readings for the season do not reflect simply a period of pre-Christmas. Rather, they focus on Jesus entrance into Jerusalem to die, his return in glory, and the preparation of repentance preached by John and all the prophets.

So as a Lutheran pastor who suffers from clinical depression, I find a great deal of joy in the season. In a chemically toned down sort of way, of course. The season reflects perfectly what it means for me to be a Christian today. I am torn between rejoicing in God’s gifts now and wanting it all to be over so we can get to the good stuff.

For most people suffering from depression, we are entering into the darkest period. It is winter, so less sunlight. It is the “holiday” season, so we have extended interaction with family, and all the conflict which inevitably ensues. For pastors, this is the start of the 3-4 busiest months of the year in terms of preaching and catechesis. EVERYTHING happens from December to early April. I always feel like I should get a medal after Easter.

Yet there is hope in this season. It stands in stark contrast to the fake and plastic joy of our culture. The hope which Christ offers is real, not contrived. There is an end, there is joy now, and Christ Himself is coming.

Be at peace, brothers and sisters. Our Lord is coming. Amen, even so, come Lord Jesus!

-DMR

depression, Pastoral Office, penacide, suicide

Another Pastor's Suicide Sparks Conversation

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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

depression, mental illness, pastoral care

On Confessing Your Illness

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I recently had a conversation with someone that centered around the question of what to confess if you suffer from depression or other mental illnesses. So many of the symptoms which we face that are bio-chemical in origin also find their origin in our fallen nature. In other words, I can look at certain manifestations of my illness(es) as being the disease “talking” but at the same time it can be my sinful nature “talking”. Here are a few examples:

  • Laziness, sloth, incapacity to work
  • Boredom, lack of interest in anything, indifference
  • Isolation from others, unfriendliness, dislike of crowds
  • Inability to handle children

Now these are just a few examples. I think that any of those three categories could be easily attributed to sin or clinical depression/anxiety.

So what do you confess?

The real mess of depression and mental illness is that they are so intertwined. My general approach is that if you are in doubt, confess it. But it is also a matter of real pastoral care, so that when I am confessing something that isn’t sin, my pastor tells me that.

Probably the dilemma comes from the fact that when you are in the throes of the darkness, you aren’t in a position to be making subtle theological distinctions. I just want relief. And at some level, I don’t really care where it comes from. IT it comes from my pastor forgiving my sins, great. If it comes from my doctor or counselor reminding me that this is biochemical and not a character flaw, great.

So how do you approach this question?

GTD, ministry

On the Ministry: Tasks Verses Relationships

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One doesn’t have to serve as a pastor for very long to come to the realization that the Holy Ministry in America is in more than a little bit of crisis. Some of the competing models for the Pastoral Office include: shepherd, maintenance man, leader, enabler, facilitator, therapist, evangelist, social worker, community worker/activist, and the like. I’m sure there are another dozen or more titles or job descriptions which could be used. It is no wonder that pastors don’t know who they are or what they are given to do!

As I have tried to think through what it means to be a pastor, I always come down to the tension between tasks and relationships. Pastors are given certain tasks that they are to do day in, day out. Preach, teach, administer the sacraments, judge doctrine, perform acts of mercy on behalf of the body of Christ, etc. I can sit down in any given week and map out all of my time in terms of the tasks that I am to do as a pastor. Of course, I just listed the nice and easy and obvious list of tasks. There is also the other, unspoken list. Things like editing the bulletin, going through the mail, preparing for and going to meetings, newsletters, correspondence, etc., etc., etc.

At the same time, nearly every one of those primary tasks of the Office only have their purpose when they are given out to the flock. My work as a pastor is about people. It is about delivering Christ to them, in season and out of season. While this again may seem obvious, it is incredibly easy as a pastor to forget it. I can get so wrapped up in getting things done that I forget who I am doing them for in the first place! Yet if I spend all my energies simply and only working on relationships, I can just as quickly lose sight that I am here to deliver Christ and not myself.

Most pastors that I know fall off this wagon on one side or another. Me, I’m much more inclined to get wrapped up in the tasks that I lose sight of the relationships. I think this is the tendency of more academic type pastors. Obviously there are many others who focus more on the relationships. I don’t think one is necessarily better than the other, but it certainly makes it so we don’t understand each other very well.

So how does one maintain the healthy balance between what we are given to do and to whom we are given to do it? Here are some of my ideas, but I’d like to hear yours as well:

1. Be aware of the tension. Lots of good things happen as a result of tension. Being mindful of it can make it a blessing and not a source of stress.

2. Pray about it. Pray that God would make you productive in the sense of getting things off of your plate AND of bringing Christ into the lives of your people. They go together. Be deliberate in your prayers.

3. Think in very concrete terms about both tasks and people interaction. Schedule it. Put it on your “next action” list. However you need to do it to make it work. But don’t just allow the water to find its own level. If that is the case, you will simply gravitate toward your own interests.

So that’s my list. What’s yours?

-DMR

therapy

Getting it outside your head

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I have been thinking and working a lot with productivity lately. One of the aspects of this learning process for me has been the benefits of externalization.

What I mean is this: I by nature keep everything inside. I let things root around in my head, create a life of their own, and become monsters that are way larger and more scary than they really should be.

Any good counselor or psychologist will do this. If you can get something written down on paper so that you can look at it with some level of objectivity, you can see it for what it is and not let the voices in your head make it into a monster.

This happens in the Psalms all the time. In Psalm 88, for example, the Psalmist is hurt and angry with God because he is near death and it appears like God has cast him away (v. 14). His words are hard and bitter, and they free him (and us) to be straight up with God and not afraid of the consequences. God is a God of mercy, not wrath.

So when something is eating at you, write it down. Tell someone else. Get it out of your head so that you can look at it for real. Take it to God in prayer. This process will be helpful to you, whether you are talking about the big things of life or the nagging thought that you need to call and make a dentist appointment.

Be at peace, friends. Let it out!

-DMR