In the Shadow of Our Steeples

Pastoral Presence for Families Coping with Mental Illness

Stewart D. Govig *Deceased*

• Éditeur: Routledge
• Année: 2013
• ISBN:
  9781135785031
• Édition: 1
• Sujet: Medicine
• Sous-sujet: Medical Theory, Practice & Reference

In the Shadow of Our Steeples: Pastoral Presence for Families Coping with Mental Illness helps you and other experts and quasi-experts in the field of religious and family counseling to give sound direction and guidance to family members who are caring for a loved one who suffers from mental illness. You'll find many avenues of care and counseling that will greatly enhance your ability to lend support and encouragement in situations where the burden of care seems too great for only a few individuals to lift. In reading it, you'll find your options increase tenfold, and you'll become a better symbol and resource of faith for these unique families. Inside In the Shadow of Our Steeples, you'll discover how to cure the obsession with success that too often goes along with counseling situations that involve mental illness. You'll also discover a greater, more enduring strain of Christian love, full of surprising joys, caring, and hope. Geared toward moving parishes away from public stigmas and toward a collective ministry of presence, this book beckons to those clergy who know and believe that a far more understanding and far-reaching form of counseling exists. Specifically, you'll learn about these and other long-sought-after aids:

• establishing theological foundations and goal-setting in the area of pastoral care
• countering the stigmas of mental illness using biblical studies and models
• using a "ministry of presence" to analyze chronic illness and promote "rehabilitation in the absence of cure"
• bringing clergy and mental health professionals into a collaborative arena of care
• improving the relationship of professional chaplains to clergy in ordinary parish settings Overall, In the Shadow of Our Steeples helps bring together the sufferer, the family, the civil servant, and the religious counselor into one synergistic group of rehabilitative influence. This sound guide's specific examples and proven strategies will help turn your despair into hope, even in the face of chronic mental illness.

PART I: LISTENER

We have forty board and care homes in our area.
Ten of them are in the shadow of our steeple.

The Reverend Joseph W. Alley
Caring Congregations

Chapter 1

The Challenge

One in every five Americans will have a mental disorder at some time in life.

Lewis L. Judd, MD
National Institutes of Mental Health

Schizophrenia is a common condition. It attacks one person in every 100 in all types of society and culture the world over. Yet it remains shrouded in secrecy, ignorance and fear.

Gwen Howe
The Reality of Schizophrenia

For the first time a young pastor had encountered mental illness in the congregation he served. “I attempted to minister to a young woman who suffered from schizophrenia,” he recalled, but “lacking the needed knowledge at the time about this illness … I am sure I did little more than provide a ministry of presence.”¹

Yet by comparison to the denial, avoidance, and feelings of powerlessness among so many of his clergy colleagues, he had actually begun a foundation for ministry. He had made himself present. In what follows I will seek to explore his modest claim of attention to the woman’s illness and thereby, indirectly, to the situation of her family as well. I will also address the hint for more direction and support in his pastoral initiative.

This will require first of all an overview of the shrouded realities of mental disorder and how the illness manifests itself.

BREAKDOWNS IN THE SUFFERER

People who depart from norms of behavior set down by the majority make us uneasy. Inside, we conclude they have crossed the line. Sometimes, in public, we label them as abnormal (“nutty”) and feel threatened in a vague way. This even happened to Jesus in his home at Capernaum. When he caused a commotion there his family tried to restrain him, for people were saying he was “beside himself” or mad (Mark 3:19b-27). A similar episode happened to the Apostle Paul. After this missionary to the Gentiles’ speech before Festus, the Roman procurator burst out with the charge, “Paul, you are out of your mind; your great learning is turning you insane” (Acts 26:24-29). Subsequent events vindicate both our Lord and his Apostle but issues related to such personal and public tensions remain. Who always sees the truth clearly? Sometimes could it even be the one made out as the “threat”? The fine line between a creative emotional experience and an abnormal one keeps moving, it seems, and is difficult to pin down.

But mental illness is different from the social deviance illustrated above. It refers to long-lasting disturbances of an individual’s thinking, mood, or behavior. Most of us have sensed periods of depression, vague fears, or outbursts of speech and behavior that make for uneasy thoughts afterward. But when the stages persist and interfere with daily living, such episodes can become symptomatic and infer something deeper. Persons who may simply appear to be dissatisfied, unhappy, or social misfits are not what I mean. Why try to cast everyday pains of living as diseases to be cured? Mental illness will strike deeper and limit one’s ability to converse with family and friends, interview for a job, get along with co-workers or perform certain duties as, for example, those of a student.²

At college when Bill found himself unable to study he would go out for long walks. But away from the campus he began to look over his shoulder because of the seven-foot-tall beings he sensed were following along the trail. By his senior year the ghosts had also pursued him to class. In addition, their voices were now audible. “Those times were scary,” he recalls, but “then I also started getting scared going to the cafeteria to eat.... I kept up my grades, but I had this other life.” Bill was suffering not only from false impressions, but from bizarre delusions completely resistant to reasoned argument. Bill’s “unwellness” pushed him toward a life of chaos and pain. When another student failed to make it for a final exam, he composed a letter to explain:

Dear Professor Smith:

I know I should have talked with you earlier, but this is extremely difficult to talk about, hence this letter. This last spring semester I took a medical leave of absence related to a generalized panic disorder. I have been working with a psychologist…

Sometimes—a lot of the time—the consequences of not keeping up on my studies can get wildly irrational and exaggerated in my mind … leading to nightmares, panic attacks, insomnia, sweating, tearfulness, hyperventilation, difficulty swallowing, and suicidal ideation (I have made a commitment and contract to not do this).

Sometimes I feel like Job in the Bible … I think God strikes me with lightning when the panic attacks cause a literal electrical sensation through my body. I want to change this because this is terrorizing me and I’m exhausted.

What’s important to me is not to lose respect from others since the extent of my relationships are distant and loss is increasingly more painful.

I need to know Hope.… I have told you probably more than you want to know but it explains something of my inconsistency. I need to pass your course. (I also needed to unload my crazy head.)

Zachary³

A young woman, Carol, described her journey into mental illness:

One night I was awakened by a man calling my name. A powerful presence filled my bedroom. I opened my eyes. There was Jesus, standing over me, right next to my bed. Next to Jesus, I felt so minuscule.… I wasn’t ready for Him yet. I was too weak. “Go away,” I said, pulling the covers over my head.

Then came the voices:

“Be good.”

“Do bad,” a second speaker advised.

“Stand up,” came the command.

“Sit down,” countered another.

I was confused.⁴

Overacuteness of the senses and distortions of visual stimuli are common: the color red becomes a glowing scarlet and a dog takes on the appearance of a tiger. Auditory hallucinations are by far the most common of these false sensations. A single voice intrudes with, “Why not?” or “Be it.” Choirs will sing. In the vast majority of cases the communication is unpleasant. Voices accuse and revile a person for past misdeeds.⁵

An energetic and effective pastor began making a series of poor judgments and bad decisions in his ministry. Trusted friends raised serious questions. His medical doctor diagnosed high blood pressure as the cause of a three-week-long headache. Sternly, she advised her patient to reduce at once his outer stress load. “But it didn’t matter,” the pastor remembered, “I didn’t care much about anything. I had no sense of what had happened to me.” The time-tested skills of making small talk, masking feelings, and pushing toward success were left behind. It was time to enter the hospital for treatment of depression.⁶

With Bill, Carol, and the pastor, the stimuli of skewed senses, delusions, and hallucinations produced an altered sense of self. This, in turn, led to a “nervous breakdown,” the popular explanation for abrupt and dramatic changes in emotions, movements, and behavior.⁷ Defining breakdown today as disease (and thereby linking it to medical measurement of body physiology) may ease the awful transits from the despair delusions generate to welcome prospects for effective treatment. But medical “disease talk” tends to objectify experience. We invoke science and try to stand apart; thereupon we lean toward presuming an eventual control and favorable outcome through medical attention from our “Medical Dieties.” Real life situations, however, must also deal with healing and cure postponements and with individual and subjective states of personal feelings, that is, with lingering disease or unwellness. Illness, Arthur Frank reminds us, can live on and on through the disease; illness talk begins where medicine (disease) discussion leaves off and admits to actualities of horror and frustration of a body breaking down. “Illness talk is a story about moving from a comfortable body to one that forces me to ask: What’s happening to me? Not it, but me.”⁸ And the question often ushers with it the companion query: Why? It can only beckon us to look for answers more urgently. From the challenges of breakdowns in the sufferers we join the search for more effective treatment and assume “it” will all some day carry only frightening memories.

ELUSIVE SYMPTOMS FOR THE CAREGIVERS

Each of the sufferers cited above were being brought to their knees by happenings beyond their control. At times restless and agitated, there was even a danger they might hurt themselves or others, especially if the “voices” told them to. Hopefully if Bill and Carol were to follow the pastor’s example, they too would have been persuaded to enter a hospital. Its locked “psycho” ward might have been required for a short time because in this refuge trained mental health professionals would get a chance to observe—in a controlled setting—the presence of various symptoms.

Therapy

Several behavioral characteristics from a baffling array would likely have arisen in each case. “Mental illness” itself involves disputable characteristics and debatable boundaries. It is generally agreed that most psychiatric diagnoses are less definitive than diagnoses in general physical medicine. Observers will note excessive elation or profound unhappiness, for example, and a given mood can sometimes blend with another. We could add signs of personality changes, difficulty sleeping, withdrawal, and unusual fearfulness (paranoia) to the diagnostic list. Furthermore, a trained mental health professional may wish to mark a degree of severity in the atypical behavior presenting itself—mild, moderate, or severe. Clinical interviews and psychological testing, plus surveys of social and personal histories, will follow.⁹ And in the search for a truthful diagnosis—similar to a biblical prophet’s—some degrees of “mental illness” will be discovered by the caregiver’s art.

A set of observations forming a pattern of behavior—symptoms and syndromes—may provide enough data over the course of weeks, months, or years for professionals to discover what they term affective disorders, schizophrenia, anxiety disorders, or dementias.¹⁰ The basis for a formal intervention emerges.

Talk therapy, self-help groups, and—sometimes in cases of severe depression—electroconvulsive therapy (ECT) may come next. Assuming along with many experts, however, that mental disorders arise in part from biological factors involving the brain (in contrast to bad habits, weakness of will, or bad parenting) medication will frequently take precedence over such psychodynamic and behavioral models of treatment.

Common medication drugs have included Thorazine, Prolixin, Haldol, and Navane. These and other neuroleptics help relieve hallucinations, delusions, and thought disorders since they appear to correct imbalances in the chemicals acting to help brain cells communicate with each other. Sometimes this therapy will become remarkably effective. As happens in the case of other medications such as penicillin, doctors are thereby able to lessen and control illnesses even when they cannot cure them, that is, remove every symptom.¹¹

Meanwhile, families gradually recognize the seriousness of these events. They place faith and hope in professional caregivers because they are the ones among us expected to know the answers. Still, “If family members encounter professionals who maintain that families are responsible for the illness, then family members will have a double burden, because their worst fears seem to be confirmed by an expert.”¹² Professional/family relations need improvements in communication for a common agenda of care.

Rehabilitation

Jess, a college student like Bill, suffered a similar collapse. When things eventually fell apart, he dropped out of school but chose to hang out with friends in an apartment near the campus. Yet not even their acceptance and friendship could calm things down. Anxieties multiplied. Next came hospital treatment lasting several months. Today, however, the young man boasts not only a bachelor’s degree but a master’s degree as well. A promising career beckons him to get on with his life. The sufferer was cured. “But,” Jess warns, “there’s such a fine line between sickness and wellness.”

People can and do recover from mental illness. Others, however, will live with symptoms more or less under control; how well such persons will function in society depends a great deal upon community support. As therapy evaluates symptoms and possible causal roots and follows up with talk and chemotherapy cure, so rehabilitation seeks to restore. This means caregivers turning away from a client’s illness liabilities and moving more toward that person’s strengths and assets. Hopefully treatment and restoration can even occur at the same time or at least in close sequence. Caregivers also appear from the “helping professions”: case managers, nurses, psychologists, administrators, and others. To reinstitutionalize persons with severe psychiatric problems following the deinstitutionalization of the 1960s is cost prohibitive. Thus an ideal rehabilitation will “assist persons with long-term psychiatric disabil...