Ministry & Mental Illness

A reader (who extended permission up front to blog this) writes:

I have been struggling lately with several serious problems doing with mental health. You see, I was headed for a Religious community and the seminary until recently, when I was hospitalized again due to being suicidally depressed.

Earlier, I just thought that my mental illness was major depressive disorder, with no psychotic features, and something I very possibly could recover completely from (I have completely recovered from this before). Although I had attempted suicide in the past, the community I was looking at was going to attempt to get me a waiver on the canonical impediment to Orders.

All of this has changed, because I recently was given a diagnosis that caused me to realize that my depression was not just going to lift, and that I will probably struggle with severe depression for the rest of my life, and it is very posssible in a fit of depression that I either attempt suicide again or succeed in committing it. So I decideded that there was  no possible way that I had a vocation...

First of all, I want to say that I understand what a painful time this is for you. I know what it's like to have to give up on a career that you wanted very much to pursue. To have reached that conclusion under your circumstances is even more painful, and I want to encourage my readers (who number in the thousands) to pray for you.

I also want to give you two compliments right up front:

First, you had the courage and presence of mind to ask for help and to write a very thoughtful series of questions, which I will address below. You should feel good about yourself for that.

Second, you volunteered to allow me to blog on this very sensitive matter. That means that the answers I give you will be out there in cyberspace where they can help other people as well. This was a very courageous and generous thing, given the sensitivity of the matter, and you should feel especially good about yourself for having made the offer.

Remember those points.

Also remember that you are a child of God and that he loves you enough to die for you on a Cross. Remember that especially. He died, so you don't need to.

And he will eventually bring something wonderful out of your suffering, because that's what he does: He turns suffering into redemption and glory. Your cross in this life may be heavier than many, but that means that your crown in the next life will be all the more glorious.

You can already see God redeeming your suffering right now, by the fact that you volunteered to let me blog this, so your suffering is leading to help for others who are similarly suffering, so they can be comforted as well as you.

Not many people would volunteer in that way.

You are a very special person.

To what degree am I morally responsible for my actions and my illness?

To the extent that your condition impedes your ability to function normally, it diminishes your responsibility for your actions. If it is not significantly impeding you at the moment then you are more responsible. If it is significantly impeding you then you are less responsible. If it is totally impeding you then you are totally not responsible.

Since you mention (below) that you are the child of two schizophrenic parents, I would assume that your condition is genetic, which means that you are not responsible for your condition AT ALL. Don't worry about that. Don't take that burden on yourself, because it is not your burden.

What you are responsible for is how you manage your condition. This means taking your medications and seeking appropriate psychological help, up to and including checking yourself into a hospital when needed.

It also means doing your best to turn away from the dark thoughts when they come to you, to set them aside and think about something else. When you sense them starting to come, do your best to think about something else--something happy. Try to remember what I've said in this post pointing out how special you are and how much God loves you.

Also, cultivate habits that will help you keep a good mood. Let me make several specific recommendations:

1) This may sound strange but . . . try a low-carb diet. You are likely to find that your energy level and mood are better if you aren't having to deal with the insulin spikes and blood sugar lows caused by eating the large amounts of carbohydrates that most Americans consume.

2) Get exercise. Find something you like and throw yourself into it.

3) As a form of enjoyable exercise, I especially recommend dancing, especially highly energetic and chaste dancing that puts you in a large group of people so you have social contact with others. Energetic dancing is a form of exercise that you won't even perceive as exercise.

I know that I'm a square dancing enthusiast, but I would especially recommend square dancing, because it meets those three qualities in spades: It's highly energetic (making it a better workout and causing your brain to release endorphins that will make you feel better), it's chaste, and it is a highly social form of dancing that will let you meet a whole group of people rather than a single partner. Also, handshakes and hugs are part of the politeness rituals associated with square dancing, and having that kind of friendly, positive contact with others will also help improve your mood.

4) Use positive language to describe your condition. Using positive language will help you think positive and thus feel positive. For example, you may want to express what you are doing in terms of "managing a condition" rather than "suffering from an illness." Both of these modes of language point to the same underlying reality, but they put different spins on it. If you focus on suffering and illness then you are likely to feel worse, like a victim who has little control. But if you think of yourself as managing a condition, you are no longer focusing on suffering an illness. Instead of being a victim, you're a manager--someone who has power over the thing you're managing, someone who can make a difference in what happens to him, who doesn't just have to sit back and take it. That's the reality of what you are, so reflect that reality in the language you use to yourself and others, and you'll find that you have more power over your situation than you thought.

I am also involved in Church ministry, and should I leave? (More than one priest who are generally orthodox in their opinions think that as long as at the time of ministry, I am ok, that it's all right.) I have my doubts, and my self-esteem and trust of myself is at an all time low.

I don't know what ministry you are involved in at present, so I can't give an opinion on whether it is the right one for you at the moment, but I think I can be of help.

The main piece of advice I would have is this: Don't think in terms of leaving ministry. Think in terms of finding the best ministry for you to pursue.

We are all called to minister to the corporal and spiritual needs of others. We are all reciprocally called to have our corporal and spiritual needs ministered to by others. It's part of the design for how Christ set up his mystical Body.

The question, therefore, is not whether we should be doing or receiving ministry. The question is finding the particular ways in which we can best minister to others and finding the ministries of others that will best help our corporal and spiritual needs.

Even people who are full-time patients in psychiatric institutions are called to do what they can to minister to the patients and doctors and staff members around them, just as the others in that environment are called to minister to their needs.

It is the same in the outside world. No matter where we are, what our life situation is, we are called both to minister and to be ministered to (the latter also includes letting others know of your needs so they can help).

So your call is not to stay in or leave ministry. It's to find the best ministry for you to pursue.

What that is depends on your inclinations, aptitudes, and circumstances.

I'd therefore ask myself what you like doing (your inclinations) and what you're good at (your aptitudes) and use that as a pointer toward what you should explore.

Once you have that in mind, consider your circumstances. There are two things to consider here: The needs of others around you and your limitations.

The needs of others (which is what ministering is all about) are an important factor here. Suppose, for example, that you enjoy being an extraordinary minister of Holy Communion a lot and you also enjoy singing in the choir. But suppose that your parish already has tons of extraordinary ministers (more than it needs). That would be a signal--based on your present circumstances--to spend time in the choir rather than as an extraordinary minister. You might enjoy being an extraordinary minister more, but that's not what the people around you need the most right now, and what their needs are is what ministry is about. You can put your talents to better use in the choir for the moment.

Notice that I said "for the moment," because circumstances change, and what ministry is the best for you right now will change over time.

This comes in particularly in view of your condition, since it changes over time. Everyone in ministry has to know his limits--otherwise he will exhaust himself and minister poorly to others. Your condition sounds like it changes significantly with time. When you're in a long-term, stable period there would be more forms of ministry that would be appropriate to you than if you're having a significant episode of depression.

I would say that, if you feel a significant episode coming on you should consider whether you need to step back from some of the forms of ministry you may be undertaking, and if you feel that you have entered a stable period then it makes sense to step forward and explore new forms.

Because of the changeability of your condition, I would also look for forms of ministry that don't require permanent or long-term commitments. You need to be doing things that you can step back from if a significant episode arrives.

I also wouldn't think of ministry exclusively in terms of a parish setting. Lots of ministry happens outside of Mass. Sometimes people who have a great desire to minister narrow their options by thinking exclusively in terms of parish-centered ministry. If you consider a broader palette of options then you're more likely to find the right colors you can paint with.

In this regard, let me make a suggestion: You're obviously a very bright guy (something else you should feel good about), and I know from things I edited in your e-mail to conceal your identity that you have an intellectual bent, so may I suggest . . . blogging?

Blogging would allow you to help others using your intellectual talents, but it would also allow you the kind of flexibility that you need to accomodate potential changes in your condition. For considerations of your privacy, I would blog under a pen name, and I would be open with your readers about your condition so that if you need to take time away from blogging they will know why and will be able to pray for you.

If you choose to go this route, you'll need to be patient while you build a readership. It will take time, and in the early days you won't have a big readership.  But if you apply yourself then, like any other blogger, you can cultivate a readership. Also if you go this route, send me another e-mail and let me know, and I'll try to recommend your site to my readers.

This is doubly painful, because I am the child of 2 schizophrenic parents who have had significant accomplishments.

I undertand your pain, and I'm going to turn this one around on you to show you what is possible: The fact that your parents have had significant accomplishments (which I've edited out for reasons of your privacy) shows you that a person with your condition can achieve things! Your own parents did, so you can too! Feel good about that!

Also, more than one friend have attributed this illness to the work of Satan, which I reject because it has a biological basis and the Catechism explicitly teaches that psychological illness should never be used as a basis for an exorcism. To what degree could the devil be involved in this?

One can't eliminate the possibility of some involvement from the opposition, but you're taking the right attitude, and the attitude which the Church would have you take (as illustrated by its exorcism policy). Your condition has a known physiological basis, and that is what you should look to in explaining it to yourself. You will serve yourself better if you don't go looking for supernatural explanations and simply trust Jesus and Mary to protect you from supernatural interference.

Also, can I receive the anointing of the sick when I am doing very badly, as it is a form of illness that is seriously life threatening? (I think Psychiatric illness that causes serious suicidal thoughts and can lead quickly to actions is life threatening, would you?)

This matter has not been authoritatively settled, but sound pastoral practice would indicate that you should be able to receive the anointing of the sick if you at the onset of a significant episode (or if a significant episode gets worse).

The Church's documents speak of people who begin to be in danger of death due to sickness and do not further specify the nature of the sickness. If the danger is caused by a condition of the heart or the brain, it should not make any difference. Mental illnesses are real illnesses, and they should count under this provision just as much as illnesses that affect other organs and bodily systems. The fact that it is processes in the brain rather than elsewhere in the body that causes the danger should not matter.

I'd also note that the English-language text of the ritual for anointing of the sick (which Rome approved) has a pastoral note stating that those with serious mental illnesses may be anointed, and the Code of Canon Law contains a canon (c. 1005) that encourages the reception of this sacrament when there is a case of doubt about whether the conditions for it are fulfilled. This, at the very least, signals that the Church wants a generous application of the sacrament so that people can get the help they need from the sacrament.

I hope this helps, thank you again for writing and for allowing me to help others by blogging this. You will be in my prayers and, I'm sure, the prayers of numerous readers. So be encouraged, and feel good about yourself!

Comments

[Anne]

This means taking your medications and seeking appropriate psychological help, up to and including checking yourself into a hospital when needed.

Just a couple of points. The advice above is good but you might want to ask a trusted family member or friend to ensure that you seek help when you aren't well because your perception of how you are feeling might be skewed.

I presume your psychiatrist has tried you on all the medications but have you tried Clozapine? A member of my family was prescribed this drug, as a last resort, and the improvement is amazing. This person has not been hospitalised for four years and has had no minor relapses either.

I applaud your courage for posting here and will keep you in my prayers.

Jimmy, as usual, a beautifully sensitive and perfectly intelligible reply.

[Naomi]

Jimmy,

Your writings for Christians who live with mental illness are some of the kindest, most thoughtful and thorough I have ever seen. I hope you will consider putting some of them in a published form (perhaps with the collaboration of a wise Catholic doctor). After all, there still are people without easy access to the Net.

And to the poster who shared his life situation with Jimmy, that he might share it with us, THANK YOU. I am praying for you!

[NonAnonymous]

Jimmy,

Bless you for your Christ-like manner in responding to this man! I join my humble prayers to all those praying for him and for you.

[Patrick]

Jimmy,

Wonderful answer. My prayers and good wishes are with the author of the letter you responded to. I think both he and you took an excellent approach to this issue.

I too would encourage the writer to stay involved in ministry, whatever form that may take.

[Jill Sawyer]

Good for you, Jimmy. I worked in mental health for 35 years, and your response was exactly right. It must have been heartbreaking for the poster to realize he would not become a priest. During Holy Week, we are reminded of Jesus' prayer in the Garden: "Not my will but thy will be done." So God obviously has other wonderful things for the poster to do! Let's keep him in our prayers.

[Mary Kay]

Wonderful post and kudos (and prayers) to the person who sent it in.

Two thoughts:

Jimmy, I think you're right about the relationship between sugar and moods, but would think more along the line of low glycemic index foods rather than low carb.

Ditto on the question about anointing of the sick sacrament. The writer is spot on that recurrent suicidal ideation certainly falls in the category of life threatening illness.

Maybe a third thought:

The writer's comment:

"I recently was given a diagnosis that caused me to realize that my depression was not just going to lift, and that I will probably struggle with severe depression for the rest of my life"

gave me pause.

Having worked in the mental health field (although not with Jill's longevity) and just now coming at the tail end of a long-term physical disability, that progress is probably more likely than it may seem to the writer at this point.

The injury or illness never goes away completely, but it can become a much smaller factor in one's life.

From a physical perspective, at the beginning of my back injury, I had to judge progress and small steps of progress, in terms of months rather than days or weeks. At an early stage, the possibility of being pain free and nearly normal mobility was as likely as being beamed up to the Enterprise.

From a mental health perspective, people who have experienced multiple trauma do indeed find that they can keep the effects more in the background than in the forefront. But that again takes time and work and often slow progress. But it is possible.

I didn't mean to ramble so long, but Jimmy gave good suggestions, especially the exercise and placing trust in Jesus and Mary.

[Sympathetic]

Jimmy,
Wonderful post, especially for Holy Week. Your reader has my prayers. Stories like this one really put one's own annoying and minor crosses in perspective. Seeing others carry such burdens is consoling, inspiring and humbling. Your reader is a real man!

[Gene Branaman]

A wonderful & thoughtful answer, Jimmy. Excellent advice.

I'll keep the reader in my prayers.

[Maureen]

Responsibility and a routine are very good things for depression. (Heck, Winston Churchill found it so.) So don't turn away from ministry.

(Don't overwork yourself with it, either.)

Also, don't forget that you're not the only person in the world who's tried to commit suicide, or struggled with wanting to do so. It's not easy to manage, but it can be done. And every day you live is a victory.

May God be with you, helping you carry this cross.

[boinkie]

Depression is, as you mention, often biochemical/genetic.
There are treatments, not always successful.
As for "not having a vocation", might I remind the writer that we ALL have vocations to holiness...and that St. Benedict Labre and also both parents of St. Therese were turned away from monasteries/convents, and found holiness in a different vocation.

[Paul]

Jimmy, I could have written a very similar letter about eight years ago. I can't say that everything is perfect today, but things are far better than they had been. Better than I would have imagined.

Jimmy gives some solid advice in this column. I'd like to add a couple of thoughts. First, without denying the graces of Anointing of the Sick, I'd caution the writer against anything that feels like giving up. Be very careful to think of this sacrament in terms of strengthening, not as a resignation to your condition. Don't do anything that feels like preparation for an early death!

Also, about ministry: I've found that a lot of people have never opened up about the psychological things they're going through. Sometimes, even a passing comment can be enough to initiate a conversation about someone's mental and spiritual life. You can have a lot of impact without realizing it. (I'm guessing that you're pretty comfortable talking about this stuff. If you aren't yet, then maybe somewhere down the road.)

[a Mom]

About dietary suggestions, I would highly recommend the work of Abram Hoffer and the Huxley Institute. See www.schizophrenia.org for more on how dietary changes can help many manage their condition.