One afternoon, I received a call from a professor who had found something disturbing on a student’s drafting table. As dean of students, I went to investigate and discovered a rash of obscene and violent messages depicted in both art and written form. So I confiscated what would be needed to document the handbook violations and assigned a member of our residence life team to track down the artist.
Close to midnight, I heard from a staff member that our missing student was seen running around campus with his shirt off in the pouring rain. They encouraged him to come in and get dry, but he refused. He bunkered down in a dumpster and was convinced he was in tremendous danger.
With my job title and my degree in counseling, guess who was called in for garbage duty?
It took a while to get this young man out of the dumpster and into the dorm, and even longer to get him to go to the hospital with me for an evaluation. Once there, thanks to a release the doctors encouraged him to sign, his history of mental illness was revealed. We learned his supply of medications was depleted, and he had stopped receiving the stabilization he needed to function appropriately.
We gave him every opportunity to return to school and to complete his degree, but it didn’t work out. He eventually returned home to enroll in long-term psychiatric care.
People on campus thought we expelled him for his behavior, but that couldn’t have been further from the truth. We just don’t disclose mental health situations over the campus e-mail. Even when accused by others of treating the student unfairly, we kept private information private, and suffered the complaints.
The lessons I learned in my decade serving at a Christian college have served me well in my new role as a pastor. I didn’t expect to find so many people affected by mental illness, meds, and their effects.
According to the 2005 Boston University Slone Epidemiology Center survey on the patterns of medication use in the United States, in any given week, 81 percent of adults in the U.S. are taking at least one medication, from insulin to Ritalin, from blood pressure pills to Prozac.
Given that staggering number, it’s obvious that a sizable percentage of the people in our congregations are on medications, some of which are mood altering or psychotic behavior stabilizers.
Does this change the way we counsel? Does this change the way we preach?
On the college campus, it became more difficult with each succeeding year to deal with medical issues when evaluating a student’s behavior and mental health. This became even harder to assess once the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996.
HIPAA was instituted by the U.S. Department of Health and Human Services to address the use and disclosure of personal health information. The law was made for all the right reasons; unfortunately, it doesn’t always work for the benefit of those who are being protected. Armed with the appropriate consent forms, we college administrators were usually able to learn of the students’ medical histories so we could stay alert to their wellbeing.
Colleges are all about developing policies, even for ministry. But what about the local church? How can we uncover the medication issues involved in our body? What do we disclose to the staff or leadership team? And what if the leaders are the ones on Zoloft?
Too often we discover a troublesome medical history by accident—or by incident. And although most pastors aren’t medical professionals constrained by HIPAA, we still feel hamstrung about sharing personal medical information.
A Series of Unfortunate Events
Something was really different about “Tammy,” one of our church’s regular attenders. She had a hard time making eye contact. She was disheveled and unkempt. She talked in an agitated and staccato pattern, as if she already knew you weren’t listening and assumed you didn’t care. She had obviously been hurt, scarred, or violated, and her tone told me she didn’t trust authority or believe
I could possibly be sincere.
I slowly pieced together her story through conversations with other women in the church. As the years passed and her church relationships grew, Tammy began to blend in as one of our own. She developed some close friendships, and she often stopped by the church office to talk with me and to pray.
Then about a year ago, and for a period of about six months, her life turned tragic. Every week there was a new development: She told us she had developed a liver disease that led to hospitalizations and the medical staff had shaved her head; the death of a close family member produced traumatic grief; she reported a clandestine relationship that turned from romantic to violent; she had wild and crazy phone conversations in my presence with people I’d never heard of. Those ministering to her tried to love and nurture Tammy through all these dramatic episodes, but we were all overwhelmed.
Her story of the death of a second family member sounded too strange to be true. It was.
With a little research, we found all her histrionics were based on lies. Even the phone calls were faked. When we confronted her with the truth, she didn’t fight us. She was defeated and broken and agreed to take steps toward recovery and mental health.
Tammy signed the release forms and agreed for us to discuss her mental health issues with past therapists and caseworkers.
What we discovered in those conversations was that Tammy’s story, like her illness, was many layers deep. The eye-opener was that Tammy had been off her medication for the last six months and had slipped back into psychotic episodes familiar to her former counselors and well-documented in her records.
We loved Tammy as best we could, in ways we thought Jesus would, but we could have served her better by recognizing her medical issues earlier.
Off With Their Meds
I am an experienced therapist who specialized in crisis work, and still I was blind to some obvious signs that Tammy was off her meds. I should have noticed some of the changes, but I think I was caught up in the day-to-day spiritual and relational issues and missed the bigger picture. In review, here are some signs that people are having meds issues—either they need meds, or are off them:
- Significant and drastic changes in mood.
- Impulsive or random behavior that is contrary to normal functioning.
- Inconsistent verbal or non-verbal behavior.
- Increased difficulty making eye contact or finishing sentences.
- Repeatedly canceled appointments.
How common is this in church life? Do people who struggle with interpersonal relationships and exhibit strange behaviors actually need to be on some kind of medication? As pastors, how can we find out this kind of information? After we do, who do we tell?
Key to addressing this issue is creating an environment where it’s okay to admit you have medication and mental health issues. I am now communicating with our congregation in a similar way I did with the staff and students at the college campus. Mental health is a reality, and so is mental illness. We all know people with phobias and disorders. In fact, we are those people.
I try to reduce the stigma by referring to standard mental health issues like depression and addiction in my messages. I use dramatic stories I’ve read as introductions or illustrations. And I try to communicate that mental health issues are not spiritual failings. God heals in many ways, including regular, carefully regulated doses of mood stabilizing drugs. And God can use these conditions to draw people closer to himself.
For some people in our congregation, such as those who ministered to Tammy through an accountability group, mental health is a ministry field. I don’t reveal names or imply that we have such cases in our church, but occasional references to mental and emotional wellbeing are encouraging to the hurting and to those trying to help them.
More important is how we handle mental health issues in our office, specifically when dealing with parishioners who come in for counseling. In most of my pastoral counseling appointments, I ask about medication history and current medications as a routine part of the intake process (see the box “Probing Questions”). I think it is a must.
This may seem intrusive, but most people are very comfortable with this line of questioning these days. If they aren’t, I simply move on. Some folks still feel guilty about taking medication for what they perceive to be “a spiritual issue,” but at least they know I’m open to discussing medications in the future. Because I raised the issue initially, they may feel free to bring it up later.
If they answer the medical questions, I take the time to research the condition on the internet, learning what each medication does and its side effects. Sometimes I call mental health professionals to ask how to deal appropriately with someone using that kind of medication. I don’t reveal names or specifics, just ask for some basic guidelines.
Once I know more, I follow-up by giving the counselee tools for better self-awareness and accountability. And I encourage the counselee to reveal the condition to at least one other trusted person in the congregation. The pastor should not be the only one who knows.
I give the counselee a copy of the information
I gathered. If appropriate, I will challenge him or her to get involved with a small group that deals with such issues—whether that is available at our church or another church in town. In Tammy’s case accountability has proven to be life altering. Although she now lives in a different city, she stopped by last week to visit. She is doing much better, she says, and her mood and behavior have stabilized. It was good to see her smile and to hear her laugh. It was encouraging to know that she has received help and that she is seeing her counselor and doctor as prescribed.
Wait a minute … I have a phone call. It’s one of Tammy’s accountability partners. Tammy’s counselor just called and said Tammy skipped her appointment again. The partner wanted me to know she would be confronting Tammy. It’s good to know that the system we worked hard to get in place is helping us care for one of God’s children.
They’re nosey, but necessary.
Here are the baseline mental health questions I ask during an initial pastoral counseling visit:
|I found out I have Bi-Polar Disorder two weeks after I was ordained a deacon. It started several years earlier with a breakdown while I was on a trip to Appalachia with two high school classmates and a Franciscan Brother. We were off to save the world.
It was there I began that roller coaster ride from manic behavior to deep depression. I spent days eating and sleeping too little and praying too much. In my mind I thought that if I ate less, there would be more for the poor. If I prayed more, I would be holy. I wanted to be a saint and decided that I would kill myself in the process if need be.
Within two weeks I was on a flight back to New York with some unknown illness. I had lost a lot of weight, I wasn’t sleeping, I experienced delusions, and I rambled on about anything. The plane ride only added to my agitated state. When I arrived home, my parents took me to a psychiatric hospital.
I spent a long and painful month in the hospital. The goal was to slow the chemical imbalance in my brain and bring me to an even pace. I left never knowing why I was admitted. Everyone hoped it was an isolated event. It was not. It was five years before I even mentioned my illness anyone. Eventually the cycle repeated itself, and again I was hospitalized; by this time, though, I was a priest. That’s when they called me bi-polar.
Heavily medicated this time, I was a virtual zombie for about two weeks. I could not carry on meaningful conversation or deal with reality. The shame remained, as my family and friends were told I was having my appendix removed.
I cried myself to sleep. I felt as if I had descended into hell. Questions flooded my mind: Why is this happening to me? Where is God now? I thought God was on vacation or something, for he certainly wasn’t with me. I felt abandoned.
What I didn’t realize, because of the medications and the disease itself, was that God was right there beside me, crying with me and for me. Even so, I focused my anger on God. I was reminded of Jesus’ innocent suffering, but that doesn’t always help when you’re aching.
I wanted God to reveal saving love by telling me that I didn’t need the medicine anymore. But God didn’t say that, and I do need it, because loving who I am means taking the medicine.
Some time later, while on retreat, the line from Mark’s Gospel hit me: “The stone that the builders rejected has become the cornerstone” (Mark 12:10). These words haunted me. The rejected stone in my life was the disease. The Lord invited me to accept and embrace my disease so that God could continue to build me into the person God intended. The shame was lifted, but the scars remained.
It has taken twenty years to “let go and let God,” but it has made all the difference. I have now been able to recognize mental illness as one, and only one, aspect of who I am. Once I could embrace that, I could be more in tune with who I am, and who God calls me to be. I was able to live life without shame.
My greatest fear was that I would experience another psychotic attack and never regain my health. Now I am confident that if this should occur, it would not change my relationship with God. My love for God and God’s love for me is so strong that when my body finally surrenders in death we shall embrace again.
“Nothing will separate us from the love of God…” Not even mental illness.
— Jerry DiSpigno Bellport, New York
Elliott Anderson is pastor of Elgin (Illinois) Evangelical Free Church.
Copyright © 2007 by the author or Christianity Today International/Leadership Journal.