For unto you this day is born a Savior

The world in silent stillness lay.

For a while this early morning there was a brief power outage.  And with the snow silently falling there was a peacefulness that enveloped the night.  Tonight we will gather to worship and celebrate Christmas.  "And on earth, peace."  These words from the angel's song ring in my ears this early morning.  And on earth, peace.

A Christmas card from a dear friend who has been reading my blog shared the hope that in the midst of my struggles I might find peace.  I find myself pondering this in my heart.

"Unto you" this day is born a Savior.  Can I believe and experience the specificity of those words "unto you"?  Will the peace of which the angels sing be a peace that embraces my life?  When God sends us a savior it awakens in our souls the imaginations of what salvation looks like.  In my own life this bipolar experience is the context from which I long for a savior.  In Bethlehem that night, words of a Savior could not be heard apart from the context of the occupation of Israel by the Roman legions.  My world is occupied by another oppressive force.

This last week my brother submitted my appeal regarding my disability insurance and benefits.  I had to removed myself from the whole process, as much as possible, as engagement in it, in even the slightest way, sent me into violent mood swings.  Asked to provide simple background information resulted in my searching through  files and in exasperation throwing them around the room.  I don't usually behave that way.  My wife has tried to intervene and to assist my brother so as to protect me from the roller coaster ride that this process provokes.  "Unto you" this day is born a Savior.

I can't hear those words apart from my experience of being captive to this disease and the control it has over my life.  The first inclination that I have is to imagine life apart from being bipolar.  What would it be like to be free of this disease?  Luther spoke of the difference between a theology of glory and a theology of the cross.  Our first inclination, I believe, is to hope to experience a theology of glory.  Victory over this disease.  Being set free from our captivity.  No more medications.  No more violent mood swings.  No more visits to that dark place in the night.  No more soaring beyond reality.  Just a balanced, peaceful life.

"My power is made perfect in weakness."  The theology of the cross, what Luther said was the only 'true theology', acknowledges quite another reality.  "Unto you is born this day in the city of David, a Savior."  God comes to us, and encounters us, in the midst of our lives.  That's what the "unto you" is about.  "In the city of David" refers to the specific context in which we live and move and have our being.  For me, the city of David, is bipolar.  The struggles that we face are not eliminated, they are redeemed.  Peace is experienced not because our 'foes' have been erased, but because in the midst of the struggle, there is God.

 "O Lord, how shall I meet you, how welcome you aright?
Your people long to greet you, my hope, my  heart's delight!!"

Rejoice, then, you sad-hearted,
who sit in deepest gloom.
Who mourn your joys departed
and tremble at  your doom.
Despair not he is near you.
There, standing at the door,
who best can help and cheer you
and bids you weep no more.

You are there.

"If I ascend to heaven, you are there; if I make my bed in Sheol, you are there."  (Psalm 139:8)

While in college I had a classmate who suffered from schizophrenia.  One of the things he discovered and shared with me was that there was a high percentage of people with schizophrenia that were atheist.  His take was that it is simply extremely difficult to believe in a God when one's life is dominated by a mental illness.

The romantic notion of body, mind, and spirit all beautifully reflecting the image of God is hard to maintain in the midst of dysfunction.  At the heart of the matter is a question of identity.  When I look back at my life and answer the question "Who am I?", its hard not to focus on the highs and lows that have defined my existence as one who is bipolar.  My former parish put a history page on their website, and they had this to say about my time there:  "During his tenure, we decided on a huge mission project, a senior living community.  Pastor Dave spent endless hours planning and overseeing the building of this community, which was named Luther Park."  They also remember the relationship with St. Nikolai Lutheran Church in Novgorod, Russia that I helped cultivate.

I couldn't be more pleased that these two things are seen as my legacy.  However, as I deal with my own diagnosis of being bipolar I am aware that the question of who I was as a pastor is being defined by two manifestations of manic episodes that I had experienced.  And though they were gracious not to write about it, I am well aware that much of my ministry there was also affected by the depression that I experienced as well.  My very being is being defined by the brain chemistry that results in the highs and lows of bipolar.  And I suppose that one could be content to rest in an understanding of our human experience as simply the product of the incredibly complex chemistry at play in our bodies.

And yet in the midst of it all, God is there.

My faith experience has been shaped deeply by the presence of God during the highs and lows of my life.  During the manic phases of my life I have had a profound sense of a holy calling.  I am not alone in that, I have heard the stories of other bipolar pastors who have had similar experiences.  Though it is worthy of note, that such experiences have been defined by the psychiatric community as religious delusions, a symptom of bipolar disorder and other conditions such as schizophrenia.

And looking back at the lowest points of my life, I have been touched by God's presence there as well.  When I was overcome by my depression and spiraled out of control in my drinking, nearly drinking myself to death, it was at the bottom that I experienced the redemptive hand of God.  That presence came largely through the people God surrounded me with at that moment.  A wife who remained by my side  in spite of my being  in a rage and drinking heavily.  Close friends who literally picked me up off the floor and cared for me.  A bishop who did not abandon me, but walked with me through that time.  A psychiatrist who dropped everything he was doing to arrange a place where I could get the treatment I needed.  The hand of God, present, gracious, and loving in the midst of despair.

If I ascend to heaven, you are there; if I make my bed in Sheol, you are there.

So the psalmist wrote.  And so I have experienced God's presence in my life as well.

This I believe is at the core of the Christmas message.  That God comes to us where we are, and there redeems our life.  Yes, manic phases have shaped my life, and yet I believe that God was present in them, redeeming them.  Luther Park is a reality, after all.  Hundreds of people have been touched by that ministry, and thousands more will be.  God is in that.  And in the dying and rising that defined my own personal holy week, October 14th and 15th of 2012, God was present.

Either that, or it was all just a matter of brain chemistry.

I choose to believe it was the hand of God.

Souls of the Night

As evening fell last night, about 7 pm, I found myself on the couch barely able to keep my eyes open.  Nothing too surprising about that as I had woke up at about 3:30 am yesterday morning, had put in a relatively full day in my shop and working on the computer, AND, 8 pm has been my normal bedtime for a while now as I'm required to get up at 4 am to commute to my new job.  So, a little drowsiness in the evening is to be expected, right?

And then it dawned on me.  Which pills did I take at supper?  Yup.  Turns out that when you take your evening medications at 6 pm, which include four different pills all of which have a side affect of making you drowsy, you are simply not going to be the life of the party for long.  Surrender.  Go to bed.  Either that or be prepared to sleep where ever you fall.

The downside of that is waking up at 1:30 in the morning.  Its now 3 am and I've already completed an estimate for a commission.  An aside:  I've been asked to bid a wine cellar.  The capacity of it, when all the racks are built, is 1,413 bottles of wine.  It probably is a good sign for my own recovery that I can now stand in such a wine cellar, and be unmoved by the vast quantity of 'the good stuff'.  I built their cellar in their current home, and now have been asked to duplicate it in their new home.  Lots of wine.  I'm thinking its a good thing though, that this is a wine cellar and not a Scotch cellar.  I'm thinking that if you had a Scotch cellar with 1,500 or so bottles of single malt, you might just be able to get intoxicated from the air in the room -- but that's just me.  Thankfully, I feel quite secure in my sobriety (1,155 days and counting) and can contemplate doing this.  However, the alcoholic in me thinks "Imagine it.  1,500 bottles of Scotch, a lazy boy, and a few good cigars.  You'd be set for a long hard winter."

Back to the reality.  I sit in silence.  I listen to the night.  I contemplate.  I wonder how much of my life has been lived under the veil of darkness.  I used to stay up late, during my drinking days this meant at times till 1 or 2 in the morning, until the Scotch had finally taken it's toll, and I could sleep.  After going through treatment and now as I live in sobriety, the cycle has shifted.  Early to bed, and then I wake in the middle of the night.

Random thoughts.  I preached about heaven a few weeks ago.  Isaiah's vision of the peaceable Kingdom was of the lion laying down with the lamb.  A reconciled creation.  And all the nations of the world will march into the new Jerusalem.  Reconciliation, not retribution.  Why is that so hard to fathom?  The gates will never be closed by day, and there will be no night.  What a welcoming place.  The ultimate open door policy.  And yet I'm struck by how many Christians are convinced that this will be an exclusive club, more about who cannot enter, than who can.  

I hear the dog stirring.  She sleeps in the kennel just to the left of my desk as I write.  A companion in the night.  I think about such faithful companionship.  A sign of the grace of God that we would be blessed with a creature so equipped to offer unconditional love without fail.

Sleep.  Illusive.  Its been a long time since I've had a non-drug induced night's sleep.  A long time. Maybe 1998, or so.  Before that I walked late into the night till exhaustion set in.

I think about my family.  We're at that wonderful time when our children are beginning to find their life partners.  We're expecting our first grandchild.  I remember one mother who prayed for the well being of her future son and daughters in law from the day her own children were born.

During the course of my ministry I sat vigil throughout the night on a number of occasions.  It was Holy Time.  Often it was during the last hours of the life of one of the souls in my care.  Sacred space.  Sacred time.  At such times the silence of the darkness is like the pregnant pause as the orchestral conductor raises his baton just prior to offering the downbeat.  You know that the heavenly chorus is ready to break into song, but just not yet.

In Jewish time, the day begins at sundown.  Light is a gift.  We move from the darkness into the light.  It is fundamentally a hopeful posture.

Darkness is often seen as the foe to be overcome.  We seek to avoid it.  Light is good, darkness is evil.  Its a primal fear within us that must kindle a fire to drive the darkness away.  Much the same thing for silence.  We fear it.

When I read the first Creation story, I'm struck that the first act of Creation is "Let there be light."  Yet I want to step back one eternal moment and imagine.  God sitting silent in the darkness, brooding over the face of the deep, and conjuring up the images of Creation.  I know that the Orthodox speak of the uncreated light of God that has always surrounded his Being.  And yet, the image of God, embracing the night, and reflecting on the vast variety of images that would be the Creation rings true to me.  There in the night he conceived the image of a platypus.  An orangutan.
There in the silence God envisioned the dolphin's graceful swimming.  The flight of the eagle.  The delightful dance of a young deer.

Its 4:30 am now.  I contemplate whether I should make the couch my residence for the next few hours.  Perhaps, I will rest.  Or I could go out into the shop and work a few hours.  I'm assembling some chairs for a client in San Jose.  I debate whether the sound of my work would interrupt those who do sleep through the night in my house.  The power screw driver has an irritating noise as it impacts the screw.  No, I will not violate the silence of this night.  I will lay down.

And bid adieu to the souls of the night as I wait for dawn's first light.

Fragility

'Twas a simple question, really.  It should have been no big deal.

My brother is preparing the appeal of my denial of disability benefits.  He needed some simple facts, such as, "What was your salary when you became disabled?"

I would speculate that a 'normal' person would respond to that question by taking a couple of minutes, looking up the information, and sending it off.  Done.

However, for me, it simply ruined my day.  The instant I saw the note with the request that was being made I went over the cliff.  I had been feeling quite good.  My wife had observed that when we went out to dinner with the kids the night before it seemed that I was doing better than I had in a long time.  "How much did you make?"  And then the spiral down began.

To get the information was one of the most labored tasks I've undertaken in a long time.  I had to go through some files to put my hands on the documentation.  And with every page I turned, a negative memory was brought to mind and I spiraled deeper into depression.  I would complete a small step of the process and have to go out for a smoke.  My smoke breaks were punctuated by collapsing on the couch, unable to find the motivation to complete the task.

And then another 'old foe' came to call.  PTSD.  Or as I prefer to call my iteration of it, Post Traumatic Church Disorder.  Every negative experience I've had with the Church came rushing to the fore.  One voice within my head said "You're making a mountain out of a molehill.  The Church cares about you and will do what is right."  Another voice said "Fool!  Whenever the chips were down the Church has screwed you in the past, why, why, would you possibly even consider that the Church would do anything different now?"

Not only did I imagine that all appeals would be denied, but I imagined that the Church would determine it was a mistake in the first place to give me the disability benefits and DEMAND that they be repaid.  And given the fact that there is no way that I could repay the three years of income that I had received, they, as in the Church that I have loved and served throughout my life, would seize my house and pensions and I would be destitute.

Then my survival instincts kicked in.  Run!  Spare yourself the risk of the fight, and flee!  Drop the appeal, and simply divorce yourself from the Church.  Rebuild your life centered on something more stable and just than the Church which has been so capricious and cruel.

My guess is that a normal person probably would not react this way to that simple question, "How much did you make?"

Grizzly bears are real

We have an issue with our very cute labradoodle, Kinzie.  Every time we let her out into the back yard she immediately starts barking, warning the world that this is her territory, and defending our home and family against all the potential threats.  From a dogs perspective this is necessary behavior.  Writ large in their DNA is the awareness that there are creatures out there, like grizzly bears, that are a real threat.  And so there is this conversation that takes place.  "Kinzie, quit barking, there's nothing out there."  And in her doggy way she responds, "But there could be!  I must be vigilant and keep you safe!"

The problem is that in addition to her DNA that hard wires her to try to protect and defend us from all harm, there are in fact real monsters out there and she knows it.  A few weeks back as I went out to again try and quiet her barking I realized that this time there WERE "monsters" out there.  She was in the midst of chasing away from our back fence the three moose that frequent our neighborhood at this time of year.  In her mind, this validates all the barking, and her vigilant efforts to keep us safe.  Moose are real.  Grizzly bears are real.  You must always be on guard.  Never rest.

As I deal with being bipolar, there are times when I feel like I'm becoming much more like Kinzie than I care to admit.  The slightest twinge of depression sounds an alarm.  Am  I going over the edge?  How long will this last?  How deep will I go?

And then at other times, when I start feeling well, when optimism creeps in, when the world seems to be opening up with possibilities, I tend to brace myself wondering if a manic phase is on the way.  Will it be manageable?  Will it be a pleasant productive 'high', or is it headed toward a psychotic departure from reality?

An inner voice barks incessantly at the back fence warning of the threats of the highs and lows that goes with the disease.  Depression has come close to taking my life.  Manic phases have cost us, and the Church, a lot of money, among other things. These are not  imaginary monsters, I've experienced them.  Like the moose in the back yard, they have been present.  They are real.  But not necessarily on this day.

Case in point:  I got a call yesterday.  Simple call.  An inquiry about whether I'd be willing to make a wine cellar for a client.  I had helped make a wine cellar for them numerous years ago, and now they are building a new house, and need a new cellar.  No big deal.  Now I'm actually working as a woodworker, not a pastor, so why does the inner dog start barking at the back fence to ward off the potential threats.

Well, its the thought process.  My mind starts racing.  Time to buy that new thickness planer that will be so helpful in completing this project.  I'll do this differently so as to realize a substantial profit.  I've finally turned the corner.  There is now no limit to the possibilities.  Hard work has paid off.  Now is the time, go for it.

On the other hand, its simply a commission.  I'll charge for the materials and receive compensation for my time.  And no, its not necessary to go out and retool for this to be profitable.  Just do the work.  Receive the pay.  And move on.

Yet manic and depressive episodes are real threats.  I think that I'm more capable today of recognizing when my thoughts and mood swing into either manic or depressed thinking patterns.  I recognize most of the time that there is a difference between what is happening in my head, and the reality of what is really out there.  And yet I find myself behaving like Kinzie.  Barking at the back fence to ward off the threat of a monster that is in fact, not there.  Today, its not a manic episode.  Its not a deep depression.  Its simply the ups and downs of normal life.

Come, Lord Jesus!

It is one thing to make the affirmation that Jesus is the savior that came into our world, and who has promised to come again.

It is quite another thing to acknowledge that we need a savior.

Yesterday I wrote about how the demands of life can push to the periphery the issues surrounding mental illness.  Sometimes there is simply not enough time to dwell on how I feel.  Just do the next right thing.  Push onward.

Last night, I tried to go back to my old medication for sleep, as it is much more affordable.  Beginning at 12:30 am, I awoke.  From that point onward sleep came in fifteen to thirty minute intervals until I arose at 3 am.

Perhaps the ability to focus on our mental health issues, and the wherewithal to devote much time and resources to addressing them is a "dubious luxury of the well to do".  But then reality sets in and interrupts our efforts to simply ignore those issues, working through them, and hoping they will simply go away.  No, this is real.  And while I currently have less time to pause and reflect, that doesn't change the impact of the mental health issues on my life.  Argh.  "Wretched man that I am!  Who will rescue me from this body of death?"  (Romans 7:24)

I have been struggling with the changing circumstances of our finances and  the impact of that on my ability to continue my therapy and medications.  One hope is simply that the resources will be there that would enable me to continue my therapy without concern for finances.  Is the solution to seek out prescription drug assistance through the various channels out there?  Are our finances dire enough to qualify?  Or do I fall into the crack?  Too wealthy to qualify for assistance, but not well enough off to be able to afford the meds.  These are  tough questions with no easy answers.  I find myself driven to create a solution to this problem.  I can do it.  It's just about being resourceful enough.

And then, I remember something I've learned in AA.  Sometimes the only way to be set free from those things that would bind us is via the path of total and absolute surrender.  This is counter intuitive.  Every bone in my body wants to believe that if I simply try harder, don't give up or give in,  and seek to gain the upper hand, I'll get through this.

But no one has ever delivered themselves.  Unless one surrenders, unless one recognizes one's utter powerlessness in the face of insurmountable  challenges we simply will not be open to the savior that God is sending our way.  Throughout my career as a pastor I preached about the Savior.  The most difficult thing that I've ever had to do is to believe and to acknowledge that I need a Savior.  Lord, have mercy.

And "Come, Lord Jesus!"  "Come, Lord Jesus!" because I really need you.  Advent is about one thing more than anything else, if it is anything at all.  And that is that we need a Savior.  That we cannot do it ourselves.  That everything, finally, depends on God's gracious intervention.  "Come, Lord Jesus!"

Life intervenes

Since October 15, 2012 I have had the luxury of a generous disability plan that our Church offers.  It has provided me the opportunity to heal, in many ways, and to adapt in others.  My main job was to focus on my own mental health issues, taking advantage of the time to engage in extensive therapy.  I had the luxury of a steady income that paid the bills while I sought to develop a business that I believed would be my best option for getting off of disability.  I also had the luxury of a medical plan that paid for the various therapies, at a very reasonable cost to me.

Then came the notice that the disability benefits would terminate.  The business, Olsons WoodWorks, has yet to become profitable, at least to the extent that one could reasonably expect to rely on it to pay the bills.  And so, the question was forced upon me, "What now?"

One option that we immediately explored was to appeal the determination that I was no longer eligible for disability benefits, and we may yet go forward with that appeal.  Time will tell.  As part of that appeal process I needed to research jobs for which I might be qualified, and at which I could earn a reasonable income.  Since 2012 I have had my eyes on the market and in that time I found no openings for a woodworker.  Then, as I did the research, I discovered one.  And so I interviewed, was offered the job, and have gone to work.  The question of whether I appeal the decision on the disability claim will largely be determined by my ability to perform well in this new endeavor.

The schedule is, quite frankly, grueling.  Up at 4 am, on the road by 5, work a ten hour day, then return home by 5:30 pm.  I eat supper, watch a couple episodes of MASH reruns, and then crash in bed  only to repeat the same schedule the next day.  Thankfully, its only four days a week, and I still have the opportunity to be in my own shop over the weekend.

The routine makes it difficult to schedule appointments with either my psychologist or psychiatrist.  And the demands of a high production cabinet shop mean that during the day its all about simply cranking out the next piece of work.  No time for reflection.  And shear exhaustion has resulted in my sleeping better than I have in decades, to the point that I'm considering going off my sleep medication and seeing how that goes.

It raises a question for me.  Are mental health issues, or at least the ability to focus on them, a dubious luxury of the 'well to do'?  Conversely, are the rigors of a working class life simply so demanding as to push to the periphery any consideration of the mental health issues that one may have?

To an extent, this is not something new.  One of my primary defenses against being overwhelmed by depression has been to keep myself so busy as to simply work through it.  No time to think,  No time to 'feel' depressed.  And if the duties to which I devoted myself were routine and normal, then even as I cycled into more manic phases there was not the opportunity to engage in those activities that crossed the line.

In AA one of the principles is to do the 'next right thing', to live in the 'now', and to avoid at all cost either dwelling on the past, or worrying about the future.  Again I find myself wondering if our tendency to spend too much time ruminating about the past, or contemplating the future, is simply a luxury that many in our world cannot afford.  And perhaps the demands of a blue collar working schedule of getting up and putting one foot in front of the other, taking one task at a time, day after day, may be good medicine.

I wouldn't insure me, either. . .

The thing about health insurance is that is it not profitable to insure the sick.  A much more reasonable business plan for an insurance company is to convince all the healthy people in the world that insurance is necessary, and to deny coverage to the sick, and as a result, all of the clientele that you insure would have little need of the insurance and all those premiums would be profit.

But having said that, insuring someone like me just doesn't make sense for the insurance company.  After all, bipolar is an ongoing condition, its not just going away, and the costs can be high.  One of our concerns now that we are shopping for coverage is the cost of prescriptions.  Many of my meds are available at a very reasonable cost. But some are not.  One pill used to cost $30 a day, now reduced to $20 a day, because it has been released as a generic (still only one allowed manufacturer but they've offered a 'generic' alternative).  A second pill, used for sleeping, has been wonderful in that I'm now getting a full eight hours of sleep.  That one costs $10 a night.  Combined with the other meds that's over a thousand dollars a month just for prescriptions.

And then there is the therapy that I've been receiving.  I don't remember the exact amount, but the full bill for a visit with my psychologist is around $180 per session, double that to see the psychiatrist.  Of course the insurance carriers have negotiated step discounts.  But even then, a few visits to the psychologist and a once a month with the psychiatrist and we can add another $500 that has been covered by insurance.  Bottom line is that for an insurance company to make a profit on me, the premiums would have to be more than $1,500 a month.  We can't afford that.

So then, forced by economic uncertainty, I must explore other options.  This is what the insurance industry is trying to accomplish, and I guess, to a certain extent I can't blame them.  How much is a good night's sleep worth?  If you can get a so, so, night's sleep with a cheaper medication why spend over three hundred dollars a month to realize an improvement?  Likewise with the other medication.  Abilify is designed to increase the effectiveness of the anti-depressants I am on.  But does its effectiveness justify $600 a month?

When insurance is covering all of these meds, it is easy to simply assert that I need whatever medications that will be best for my health and the maintenance of a reasonably stable and normal state of being.  When its coming out of our own pockets, then we are forced to do a cost/benefit analysis.  And in the back of my mind is the recognition that in spite of the temptation, the cardinal sin of being bipolar is going off of medications that are stabilizing one's mood.

And then there are other inappropriate thoughts.  My alcoholic mind says "I was doing just fine relying on Scotch, and for a lot less than $1,000 a month."  Actually, a thousand dollars a month would buy some very good Scotch.

The other thought that comes to mind, more reasonable than Scotch, is running to Canada.  This is the second time this  has come up.  Moving there is not really an option.  But I know that others in the past have gotten a physician in Canada to prescribe the meds, and then purchased them at a Canadian pharmacy for a fraction of the cost in the States.  I don't know if this is legal anymore.  But with Canada only 50 miles away, it is a thought that comes to mind.  I could drive to Creston, BC for less than $1,000 a month.

Oh well, things will work out.

In the mean time, it is Thanksgiving, family is coming, and I'm looking forward to the day with meds that will last a week before yet another decision will have to be made.

Capitalism, Health Care, and the Mentally Ill

Sometimes we hear about the struggles of health care in the USA.  At other times we experience it.  Our health care system is driven by profitability, even when the providers are not for profit.

In my situation, the reality has hit home hard.

I was informed that my disability benefits were being terminated.  We are considering an appeal.  Time will tell.  However, in the mean time, our family's health benefits which had been provided through the disability benefits were also terminated.  We received this notification approximately ten days AFTER they had ceased.  Which of course was more than a bit disconcerting.

We are eligible for COBRA.  The quoted price for COBRA was $2,666/month for the family or $860 each for my wife and I.  Having just lost the income from disability, needless to say, coming up with that kind of cash for health insurance simply wasn't possible.

We are fortunate.  My wife can get insurance through her employment.  Her's is largely paid for by the employer, mine costs a significant amount, though only a fraction of what COBRA would have cost.  I thought, "One hurdle crossed."

Well, not quite.

When I went to pick up my prescriptions this week Regence rejected the claim for  two of my meds resulting in my having to purchase a ten day supply at a cost of over $350.  My physician will have to make the case for those meds being covered, but even then, because they are not yet available in generic forms, there will be a $500 deductible for both this year and then of course, beginning next year.  OK, we'll see how this works out.

Then I went to my psychologist.  Gave them my new insurance number.  Rude awakening.  No mental health benefits.  No coverage for the psychologist.  No coverage for seeing the psychiatrist.  Still waiting to see if this means no coverage for the medications that I am receiving for bipolar disorder.

The bottom line is that we will have to be shopping the insurance exchange.  Don't know if we will be successful or whether the coverage that we need will be simply too expensive.

Other options are to have my family practice doctor take over the prescriptions.  My psychologist offered to try and work out an affordable fee structure.

The question with which we must struggle is whether I can continue the treatment I need at a cost I can afford, and what happens if the answer to either of those is "No."

The bottom line, is that when we structure our health care system on the basis of capitalism, it will always be in the best interest of the insurance industry to find ways to deny coverage to those most need it, because it is much more profitable to insure healthy people than sick people.  At the same time physicians must charge enough for their business to be profitable, which makes paying cash for their services unattainable for those who most need it.

I wonder if there is a need for a good woodworker in Canada?

'twixt Hope and Despair

Dare to believe.  Sounds like a good motto.  And yet there is a need to reconcile what is in our head with the reality of life that we encounter.  Hope springs eternal, despair comes with the night.  As a person of faith I am drawn toward a life of hope.  For good reason.  The moments of grace that have come into my life as pure surprise are many.  From my mother's womb you have cared for me, O God!  We know so little about the future that to surrender to our fears is simply not called for.  How many times have seemingly insurmountable odds been overcome by God's grace?  Too many to count.

And yet at times the painful reality of life also sets in.  To assert, as a matter of faith, that suffering will not overcome us can seem naive.  Truth speaks of suffering far too often.  Sometimes the news is not good.  Poverty is real.  Fears sometimes are realized.

As a pastor, thinking back over all the words of comfort I tried to offer, the words I most regret were "We fear the worst, and it almost never happens."  These words I spoke to a young man who was getting tested for a weakness that had developed in one leg.  A couple of months later he was dead, the result of a super aggressive brain tumor.  Evil happens.  It doesn't ALWAYS work out.

Fear exists only in our minds.  But I suppose we could say the same for hope.  The struggle I'm faced with today is how to negotiate the  uncertainties of the future when that natural presence of fear and hope is coupled with being bipolar.

I once bluntly declared, "God flunked chemistry!"  It was my reaction to the delicate chemical balance that has to be present in our brain, but all too often isn't.  Of course, we're not too good at chemistry either, otherwise we could easily restore the brain chemistry to a healthy balance and mental illness would evaporate.

For one who is bipolar, sometimes mania masquerades as hope.  We can solve the problem of world hunger through hydroponic gardening.  Everyone self sufficient for their own food.  That was the deep conviction of one who was bipolar.  During one manic episode I became convinced that the entire Church could be transformed by adopting the twelve step model of AA.  The Kingdom of God is at hand.  And all we needed to do was to reclaim in a powerful way the rite of confession and forgiveness practiced in church basements across the country by alcoholics in recovery.  Hope springs eternal.  Either that, or mania has set in.

And then there are our fears, and the despair that often accompanies them.  Sometimes we are afraid because there are some very real threats out there.  And then there are also those times when the darkness that comes over the world is not real.  Its not that 'hordes of devils fill the land', its simply that the chemistry of our brains is off balance, and we are in a depressed episode.  Hang on for a while.  It will be alright.

When is hope a gift of God's grace?  And when is it simply a matter of the unbridled optimism of a manic state?  When is fear a healthy survival tool amid life's real threats?  And when is it simply the result of brain chemistry run amok?

No answers today.  Just a commitment to trudge onward in the midst of it all.

Catch 22

"You mean there's a catch?"
"Sure there's a catch", Doc Daneeka replied.  "Catch-22.  Anyone who wants to get out of combat duty isn't really crazy."
There was only one catch and that was Catch-22, which specified that a concern for one's own safety in the face of dangers that were real and immediate was the process of a rational mind.  Orr was crazy and could be grounded.  All he had to do was ask; and as soon as he did, he would no longer be crazy and would have to fly more missions.  ("Catch-22 (logic), Wikipedia)

I love that.  Twisted logic.  It's fun until you are faced with it.

As I look at appealing the insurance carrier's denial of my disability benefits I was reminded of the "Catch-22" that is often at play.

If someone has a mental illness that results in a disability then they are entitled to disability benefits.  If denied, they have the right to appeal the decision.  However, if they are capable of appealing the decision they demonstrate that they are not disabled.  Catch-22.

Or to put it differently, appealing the decision of the insurance company to deny disability is an overwhelming task.  The more disabled, the more overwhelming the thought of formulating an appeal.  Hence, the least likely to be able to appeal the decision are the one's who most need it to be overturned.  Makes sense, doesn't it?

I wish it were that simple.

If at any point in time a bipolar person experienced either a full blown manic episode or a deep depression, it would be easier to diagnose.  In my experience it has simply not been that distinctly polar, or black and white.  Some of the most helpful insights into bipolar that I have found are from a Doctor Jim Phelps, online at PsychEducation.org .   I cannot vouch for his standing in the psychiatric community, and there appears to be many differing opinions about bipolar within the psychiatric community.  But as I review my own experience, there is much that resonates with what he has to offer.

One of the most helpful things that he has identified surrounds the different waves that people with bipolar experience.  The basics are as follows:

One's symptoms are controlled by three separate 'waves', and each can cycle independently of the others.  Those distinct waves are mood, energy, and intellect.  In a classic manic phase all three waves top out with elevated mood, increased energy, and heightened ability to think, create, and pull everything together.  When all three bottom out with a dark mood, decreased energy, and clouded thought patterns you have a major depression.

But those waves do not cycle simultaneously.  For example, if the energy curve is up, but the others are down, the person experiences an "agitated depression".

It is also the case that many bipolar people experience a "mixed state" where they may experience a variety of symptoms that cross over the spectrum from manic to depressed.

Now to the crux of the issue as to my current situation of being evaluated, tested, and having the insurance company determine whether I am 'disabled'.  What is most irritating is that often in this process they want to make an evaluation on the basis of a snap shot. "How are you feeling today!"  Ok, well, today I might feel mildly depressed, or generally normal, or ready to take on the world, or in the fits of despair.  Depends on the day.  Someone who is bipolar cycles back and forth between manic and depressed states, and much of the time in between those extremes one may feel relatively normal, healthy, and functional.

"How do you feel today?"  "Fine."  "Then you should not be on disability and need to get back to work."  OK, but last week I might have been having suicidal ideations and next week I may be ready to save the world.  You cannot make a comprehensive diagnosis based on anyone of those states without considering the others.  Bipolar is a spectrum of experiences, not a unified state of being.  That's one of my major problems with the insurance companies that want to evaluate my situation based on the observations of a psychiatrist who has only seen me for one appointment.

My mother used to quote an old adage, "if you don't like the weather in Montana, wait five minutes and it will change."  That applies to being bipolar.

http://psycheducation.org/diagnosis/mixed-states/rapid-cycling-and-mixed-states-as-waves/

Testing, 1,2,3, Testing

The insurance company that handles our disability benefits did not like it when my psychiatrist told them that my Type I Bipolar diagnosis was a permanent disability that significantly impaired my ability to work.  They terminated the benefits effective the last day of October, and with that my medical insurance.  What lies ahead is the appeal process that can extend over 90 days.  Meanwhile we are without the income that we have been relying on.

"This is a test of the emergency broadcasting system.  Were this a real crisis you would be told what to do."  I think that is what the original announcement used to say after the obnoxious beeps.  At least with the emergency broadcast system there is a promise that you would be told what to do.

This is an interesting test in that the crisis brings everything I deal with to the fore.  PTSD is active and alive -- fully expecting to be screwed big time by the Church I have served.  Note to insurance company, "if you are going to cancel our health insurance it would be appreciated that we have some advanced notice. . ."

I find myself torn between the couch, and sitting and smoking away the day on the porch.  Amazingly, I've started sleeping in excess of 8 hours a night.  Insomnia has always been a problem.  Excessive sleep is a symptom of depression.  I find myself mired down in the fear of loosing everything we have, everything we've worked for, and every hope for the future.  Depression is a cruel companion.

And then the manic thoughts start raging.  Explore every option.  I built Luther Park and created the jobs for 70 plus people in this community,  I can do the same now for me.  Invest in a more viable business.  Convince an employer that I could do anything they ask of me, just a little orientation required.  Buy and flip homes.  Re-enter the ministry.  Damn right I can do something, in fact, given a chance I can do anything.

And then the shaking resumes from the partial complex seizures.

The basic reasoning of the insurance company is that I'm not reported to have any significant cognitive or physical disability.  (My psychologist recommended I become a Republican and run for president.  His assessment, I think, was that I'm more qualified and capable than the current candidates. . .)  I will have to prove through the appeal process that though Bipolar disorder and PTSD do not constitute a "physical", or "cognitive" disability, but due to the nature of mental illness they are disabling none the less.

And then, simultaneously, I need to explore possibilities of what I can do to care for our family as I am able.  In some ways this fits right into the nature of the bipolar disease.  The depressed side is ready to make the case that there is simply nothing that I can do.  The manic side is convinced that there is nothing that I cannot do.  Competing voices raging within.

I'm exploring with my bishop what ministry options there might be for me.  I felt the need to do "full disclosure".  "That said, the most damaging potential of my being in ministry would be if during a manic phase I did engage in inappropriate sexual behavior.  Obviously, I have no intent of doing that, but in that a manic and hypomanic episodes involve "distinct change in mood and functioning that is not characteristic of you," we have to acknowledge the risks".  Such are the risks associated with this disease.  There are significant risks of legal liability if the Church, knowing that I am bipolar, and knowing that "sexual indiscretions" are one of the defining symptoms of the disease, were to put me back in the parish.  Maybe not insurmountable.  But significant.  Of course, knowing the symptoms of the disease I wonder what employment is possible given the risks.  That I suppose is the question.

I'm told that this is standard procedure for insurance companies.  They will deny the claim simply to make you prove your case.  They hope, of course, that many simply won't have the will or the means to appeal the decision.  I am fortunate to have a family helping me.  Meanwhile the test goes on.

It is what it is

It was only two words, and yet hearing them had a profound emotional effect on me.  This, in spite of the fact that it really wasn't anything earth shattering or new.

"Permanently Disabled."

Those were the words of my psychiatrist in communication with the insurance company managing my disability claim.  We will see how the insurance company responds.  Hearing those words brought mixed emotions to me.

In my communications with the insurance company they have always taken the role of the eternal optimist.  "Are you improving?"  "Are you better now?"  "We want to get you back to work."  Well, of course they do.  The sooner I am able to return to work, the sooner they can quit paying the disability benefits.  And for the record, I would enjoy being actively engaged once again in full time work and making an adequate wage and benefits to support our family.  There is honor in that.  Not to say that it is dishonorable to be on disability.  But being on disability does not produce in me a feeling of well being and high self esteem.

Part of my mixed reaction to those words "permanently disabled" is related to the nature of being bipolar.  When I'm feeling depressed it is difficult to accomplish anything.  When I'm experiencing life from the hypo-manic side of the cycle I can envision no limitations.  At those times, not only do I feel that I can work again, but my sense is that I could do most any job if I just was given the chance.  I want to say to the insurance company "Yes, I can return to work.  Give me a job.  Insurance claims adjuster.  Sure, I can do that."  Or I envision returning to ministry.  No problem.  I could be bishop.  Or Presiding Bishop, for that matter.  And returning to parish ministry would be as easy as riding a bike again.  Been there, done that, lets go.

That's when I hear a resounding "Whoa, cowboy!" from my medical team.  Ir is disconcerting to have my doctors rein me in when I'm ready to run, and then also, to have them prod me on, when I'd like to just lay down.  Sometimes there just doesn't seem to be a happy medium.

Which is the nature of being bipolar.  And that is not going to change.

In general, people who feel depressed will come to a point where the depression has run its course, and they return to feeling normal.  Being bipolar means that one will continually cycle, feeling depressed at some points, and supercharged at other times.  You don't just 'get well'.

Which brings me back to the label "permanently disabled".  On the one hand, it would bring a lot of peace and easing of anxiety if people, like the insurance company, could just settle in to the reality that being bipolar is a permanent, not temporary, condition.  On the other hand, accepting those words "permanently disabled" is to surrender hope.  Its accepting that the question is not whether one will be "well", but how well one is "managing" with the disease.

One final thought.  Part of my struggle with all this is that I simply do not know.  I do not know what remains possible and advisable for me, and I do not know what the limitations really are.  There are significant risks for me if I were to try and re-enter parish ministry.  There are significant risks for a congregation or other employer who would give me the opportunity.  There is a need to protect me from the congregation, and protect the congregation from me.  Yes, I could try to return to parish ministry, but who pays the cost if I crash and burn.  That finally, is the question that will not go away.

Who am I?

"Have you ever found yourself wondering if you are a high functioning idiot, or a low functioning genius?"

This was a question from one of the readers of my blog. This person understands.  It comes from a similar experience to my own.  It gets at the core of one of the most difficult issues for me.  Identity.

At issue is two very distinct experiences of life.  At one end of the spectrum, during times of depression, the simplest of tasks seem insurmountable.  Clarity of thought is illusive.  In my woodworking shop I find myself barely capable of completing one step, and then all momentum is lost, and I have to dig deep to reorganize my thoughts, and trudge onward.  And yet there is this memory of times that were very high functioning.  An idiot who has moments of greatness.

And then at other times I'm "in the zone".  My ability to analyze, conceptualize, and visualize possibilities is impressive.  Tasks are accomplished in a seamless flow.  Everything seems possible.  Give me a few acres of land, and a $5,000 grant, and I can turn it into a 15 million dollar senior housing facility.  Energy abounds.  Get out of my way.  I've got this.  Until I don't.  Its like a rocket being propelled into orbit with almost enough fuel, running out just before enough momentum is achieved, and then falling back to earth.  A genius that can't quite make it and continually crashes.

Somewhere in the middle there is the place of balance, if you can call it that.  That seems to be what the goal of treatment is.  Eliminate the highs and the lows and stabilize in the middle.  Sometimes I yearn to find that place of balance and stay there.  At other  times I fear losing part of who I am.

When I look at the totality of my experience I find myself wondering what part of that represents my true self.  If there was a time in my life that I'd like to relive continually, it would be that period when I was doing the development work on the senior housing.  I felt so "alive".  At other times it is the melancholy, pensive, reflective Scandinavian self that seems like the real me.  At one end of the spectrum a developer doing great things.  At the other end, a preacher probing the depths of the human experience.

The highs and the lows have so defined my existence that it is difficult to wrap myself around and identity carved out of the middle.  It seems so painfully average, nondescript.  Perhaps this is why so many people decide after stabilizing on medications to cease taking them.  There is a desire to experience the fullness of their selves, both the height and depth of the human experience.  But the disparity between the highs and lows is so profound that the extremes can seem demonic.  Or if you prefer, psychotic.  So extreme as to loose touch with reality.

Sealed with the Holy Spirit and marked with the cross of Christ, forever.  These words speak of our Christian identity.  They come to me now.  And I hear them in a bipolar manner.  Soaring like a dove, nailed to the cross.  The height and depth.  I wonder if Christ yearned for that place in the middle?

"My name is Legion, for we are many."

Sometimes what one needs is a herd of pigs into which the demons can be cast.

For many years I dismissed the scriptural stories of demon possession as relics of an age past with little relevance to a more scientific world view.  Today my sense is more that the Bible's reference to demonic possession may be more helpful than I thought, especially as it relates to mental health.  Whether its the despair that has no legitimate basis, or a grandiosity that would not think twice about throwing one's self off of the pinnacle of the temple in anticipation of an angelic rescue, there is a profound sense at times that something foreign to my true self is at play here.

"Cunning, baffling, powerful!  Without help it is too much for us."  (Alcoholics Anonymous, page 58-59)  Actually, alcohol is nothing more than a liquid.  It has no capacity whatsoever to be "cunning, baffling, or powerful".  Yet the experience of the alcoholic is that of facing an incredible, seemingly insurmountable foe requiring divine intervention to overcome it.  What is your name?

Twisted logic is as the root of this foes "power".  It controls.  We drink a depressant because we are depressed.  Insanity.  We come to a point that our lives have been wrecked by alcohol, and yet we want nothing more than to turn to alcohol to relieve the pain.  "You will not die, you will be like God."  We are seduced by the very thing that is killing us.  What is your name.

As God, a manic phase knows no limits.  I could be president, and given the chance to rule, even the nations of the world would invite me to reign over them as well.  Grandiosity. A vision for ministry and the Church that renders Christ's own perspective as short sighted, too limited in scope and ineffective.  Where do these thoughts come from?  What is your name?

And then the night falls.  There are people out there.  And yet loneliness and despair cloak the darkness.  What once was a life without limits, feels now like an impotent life waiting anxiously for sleep, or death.  A shower is a major accomplishment.  It is as if a thief has seized everything that is of value and meaning, and slipped off into the night.  What is your name?

Shaking.  An EEG reveals "mild epileptic activity" that apparently is the cause of the shaking.  "Mild epileptic activity" reminds me of the definition of "minor surgery" as being "any surgery performed on someone else".  A physical manifestation of an  unseen power within.  "This kind can come out only through prayer."  What is your name?

"My name is Legion, for we are many."

Within the scriptural stories of demon possession there is hope.  Frightening as being possessed by a foreign being can be, the thought that this being could be cast out, exorcised, is comforting.  This is not who I am.  It can be different.

Perhaps finally, the countless hours of therapy with psychologists and psychiatrists, and all the medical intervention are about this one thing.  "I command you to come out of him."  And perhaps all that is lacking is a herd of pigs.

Into the abyss. . .

Entering the subways in St Petersburg, Russia can be frightening.  The escalators are some of the longest in the world as they descend down, down, and even farther down.  One passes through the turnstiles and steps onto the escalator before you can actually see how far down the down escalator goes.  And then as the steps go over the edge you finally get a glimpse of the depths to which you are descending and the only choice you have is to ride it to the end.

Imagine, riding a ski lift down the mountain, in the dark, with no idea how far down it is, but only the sensation of the descent into the darkness.

There is a spiral stairway, of which you cannot see the ending.  If you dare look over the edge, you see nothing but stairs, one after another, each one a little lower.  Desperately, you'd like to turn around but it is as if there is an unseen force pulling you down the staircase, and all the energy you can muster does nothing more than slow the descent.

Its as if one is chasing the sun, hoping to stay ahead of the darkness that is coming, and yet, try as you might, you cannot run fast enough, and the darkness always descends, and one has no choice but to wait out the night.

It is an all too familiar path.  Perhaps, if one is lucky, there are landings along the way that provide a place to rest awhile.  It might be a distraction such as a recreational activity, a good conversation, or a good meal.  But it is short lived.  As with an escalator, one can turn around and try to walk up the down escalator for awhile.  If you are capable of walking up faster than the steps are carrying you down, you can reverse the descent.  But only for awhile, a moment, for the relentless downward momentum of the escalator is more powerful than the ability to climb the stairs.

Sensory perceptions dim.  The world goes black and white, and shades of grey.  (I realize this dates me, as there are many today who have never seen a black and white TV screen.)  It becomes hard to hear.  Sound becomes jumbled.  People seem to drift away, out of one's reach, isolation becomes overwhelming.  And then, as though cruelly planned, the force of gravity increases and your body becomes heavy, incredibly heavy, making it difficult to walk, impossible to move freely, and even while resting, it is though one is pulled forcefully into the bed.

Lying alone in the darkness, one waits for the dawn.  No effort on your part can hasten the rising of the sun.  One voice in your head screams out in despair that the sun is gone forever, another calming voice speaks of faith, and that the light will return in the morning, once again, after the night has run its course.  But first the night must run its course.

Diagnosis, an Art not a Science. . .

Sometimes it would be nice to know for sure what's wrong with me.  I'd love to have the full list of diagnoses that have been on my charts from time to time.  When I was initially diagnosed it was "dysthymia with major depressive episodes".  In laymen's terms, an ongoing mild depression that periodically intensifies into a major depression.  Ok.  I have also been labeled as having "major depressive disorder: non-responsive", as in he's depressed, but anti-depressants do not work.

But then my last two psychiatrists have thought differently.  Apparently, it is common to misdiagnose someone as being depressed when they are in fact bipolar.  The reason why the depression does not respond to anti-depressants, and continues to return, is that the person is cycling from a manic or hypo-manic state to a depressed state, and back again.  Bipolar depression is less likely to respond to anti-depressants, though anti-depressants may be part of the treatment.  Bipolar depression responds to mood stabilizers such as lithium or Lamictal.

I am convinced that I am bipolar because I have responded better to Lamictal than any of the anti-depressants that I have been put on, and I have been put on most of the common anti-depressants, and a few not so common ones.  There is a reverse diagnosis going on here that I understand is common.  There is no test to definitively diagnose bipolar.  But if you respond to mood stabilizers, and not so much to anti-depressants, then you are likely bipolar.

Bipolar I is easier to diagnose because both the manic state and depressed state are extreme even to the point of being psychotic.  Bipolar II is more difficult because there is not a "manic" state, but rather a hypomanic state, which is not as severe and may present itself as just a very high level of goal oriented, creative and productive, driven functioning.  It is pleasurable.  And then there is another category, mixed states.  One can also experience both manic or hypomanic symptoms concurrently with depressed symptoms.  It all muddies the waters.

My psychiatrist is using the diagnosis of Bipolar for me.  My psychologist is not so sure.  I find myself wondering if doctors are prejudiced in their diagnosis based on their specialization.  Psychiatrists prescribe meds, and Bipolar responds to meds, so are they more inclined to diagnose someone as bipolar?  Psychologists do therapy, and psychological disorders respond to things such as cognitive/behavioral therapy, hence are they more likely to diagnose accordingly.  I don't know.

What I know is that I have continually cycled through highs and lows over the course of my life, and that they have progressed.  The highs get higher, the lows get lower.  Sometimes the shift between the two is gradual over time.  Sometimes it is as violent as falling off a cliff.  And sometimes, I experience a cluster of thoughts and behaviors that are concurrently depressed and hypo-manic.

If I am truly bipolar, as I believe I am, then if I go off my medication there is a good chance that a full blown manic state could be triggered.  But the mood stabilizers seem to have me locked into a mildly depressed state, and quite frankly, when your best day is still depressed it is not fun.

I wish mental health issues were as clear as heart problems.  When my mitral valve failed, they could hear the murmur.  They could take pictures of the prolapse.  They could go in and repair it.  With a mental health problem, neither the diagnosis nor the cure is straight forward.  There is a wide range of disagreement within the medical community.  One doctor may be convinced that you clearly are bipolar and the next doctor convinced that you are not.  And as a patient, I am left wondering.  Is this the right diagnosis, and the correct treatment?  Or are we all off track?

The Image of God or Demons,

Who am I?  And where have I gone?  Or maybe I've been here all along.

I struggle with these questions.  Self doubt takes on a whole new meaning when one is diagnosed with a mental illness.  Is the me I've seen in the mirror the real me?  Or am I looking at the product of a disease?  An aberration?  Is the image I see the child of God I was created to be?  Or a demon?

I don't know the answer to this.  I waiver back and forth.  One way of looking at living Bipolar is to see it as the product of bad brain chemistry.  Something is clearly wrong.  Everyone experiences a natural ebb and flow of moods, but for one who is Bipolar both the highs and lows are extreme to the extent that one cannot function normally at either end of the spectrum.  It can feel like a demonic possession.  One's behavior is compulsively driven by mood, as if a foreign being is in charge, that the true self is captive and imprisoned within.  Questions of accountability and responsibility come to mind.  Is someone who is in a manic state capable of being responsible for their actions?  Or are the behaviors symptomatic of the disease and beyond the control of the person?  The devil made me do it.

But perhaps it isn't like that at all.  Perhaps being Bipolar is actually just a way of describing someone with unique capacities that extend well beyond the norm.  For example, were my decisions the pursue the development of Luther Park at Sandpoint, the senior housing facility we developed while I was at First Lutheran in Sandpoint, or my decision to invest heavily in a CNC Router for my woodworking business examples of symptoms of my disease that should have been moderated by "normal people" watching over me, or, examples of how the unique giftedness associated with being Bipolar allows for major accomplishments?  One of the defined symptoms of Bipolar manic episodes is "reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, or ill-advised business decisions).

The judgement that we make is often based on the success of the endeavor.  Luther Park is very successful.  And so it feels as though it is the product of the unique giftedness that I brought to that challenge.  My business has yet to become profitable, and so it feels as though spending over $50,000 on a CNC Router may have been a "lavish spending spree" or "ill-advised business decision".  On the other hand, look at the furniture I've created.

Does the proper treatment of Bipolar disorder enable one to eliminate the "unnatural' highs and lows, cast out the demons, and get back in touch with one's true self?  Or is part of one's true self, the capacity to experience extreme highs and lows, the heightened energy and creativity and all that goes with that, lost with treatment?  What is called for, an exorcism or a channeling of gifts?  And in the midst of it, who am I?

Warring Worlds Within

I wrote in my last blog about the interaction that I had with my insurance carrier that manages my disability claim regarding being suspended, pending the submission of  some requested reports from my physician.  In the end, the reports were submitted, and for the time being, all is good.

It was an experience.  The irony of this ongoing process of evaluation by the insurance company (Liberty Mutual) to determine if I remain eligible for the disability benefits is that the process alone aggravates the disease.  Every time the evaluative process comes up I experience a spike in symptoms.  I imagine my physician telling the case manager, "He might be able to work, except every time you ask the question, the stress makes it impossible for him to work."

One of the symptoms that I experience is partial complex seizures, epileptic activity, which causes involuntary tremors centered in my right arm.  These tremors may last a few minutes, a few hours, or be off and on for a few days.  Stress factors apparently cause them to break through, in spite of being on anti-seizure medication.  I first experienced them early on as I was concluding my time in the ministry.  It was actually the seizure activity that was a major factor in my being hospitalized for a week and placed on disability to begin with.  Then, it was being in church that provoked them, that lasted for three months or so.  Now, they return when I get highly stressed.

Saturday, following the news that my benefits had been suspended, I experienced slight tremors.  On Monday, after I received the news that my doctor had submitted the reports and that my benefits were no longer suspended, the seizure activity intensified and peaked that evening.  But that wasn't the most interesting aspect of my experience.

What started to unfold during those days I would describe as a warring madness between the manic thoughts and depressed thoughts.  It was like simultaneously both trains of thought were racing wildly, and my stream of consciousness would randomly shift back and forth between the two.

They focused our house, and whether we'd be able to keep this as our home if the disability benefits were terminated.

I could sell my CNC router to a leasing company, lease it back, and in so doing raise enough capital to make the house payment for a few years.  No, maybe a home equity loan could sustain us for a while.  We could move into a less costly rental, and rent out the house until we retired and have the income to afford the payments.  I'll double down my efforts on the business, expand, and raise my income level.  If I'm denied disability I'll return to the ministry, regardless of whether that would be a wise decision.  I'll buy a lottery ticket.  One way or another, my manic brain was scheming to figure out a way to leverage what I have to preserve what I have.  (For the record, my rational brain recognizes that as a whole these thoughts do not represent sound and realistic financial decisions.)

And then breaking up this thought pattern was the depressed side of my thought pattern.  Bankruptcy is inevitable.  Loosing the house and the equity we have in it is just a matter of time.  I'm just fooling myself to think anything will work.  I lay down in a fetal position and try to go to sleep.  And in spite of the exhaustion that all this causes, I cannot sleep -- and then another wave of scheming or despair would set in.  "I know, the Bishop will retire in the next few years, I could do that!"  (I'm still debating whether that was a depressed thought or a manic thought.)

Eventually, some calm returns.  The warring worlds within are silenced, if for no other reason, shear exhaustion.  This takes a lot of energy.

Mental Illness: Shooters, Care giving, and "The System"

As one with a mental illness, I cringe every time I hear of yet another heinous crime being blamed on somebody being "mentally ill".  It adds to the stigma of mental illness. There is a built in prejudice in such a statement, not dissimilar to  saying "The murderer was black."  The murderer may have been black, but being black does not in anyway predispose one to being a murderer.  Or to put it in other words, imagine a news reporter saying, "This is yet another case of a blond person murdering someone."

Having said that there are some basic facts to acknowledge.  Anyone -- truly anyone-- who commits murder can be diagnosed with a mental illness.  Of course, mentally healthy people simply don't go to school armed to the max and start shooting.  Mentally healthy people do not do things like murdering their family and taking their own life.  There is a diagnosis in DSM for absolutely everyone that would engage in murderous activity.

Mentally healthy people don't murder other people.  But neither do the vast majority of people who struggle with mental illness.

A psychopath is a person with an antisocial personality disorder, manifested in aggressive, perverted, criminal, or amoral behavior without empathy or remorse.  I might react more favorably to a reporter saying that the "murderer was a psychopath", than to the more generic "mentally ill".

Having said all of that, I appreciate the sentiment behind calls for better care for the mentally ill in our society that often come up following a shooting.  Although, lets be honest.  Not a lot of psychopaths are going to seek out the care of a mental health professional.  You will never find a "Psychopaths Anonymous" group.  For the sake of every one who struggles with mental illness, it would be nice if the general level of knowledge and awareness was increased across our society, and especially within the "system" that is designed to support and care for those with a mental illness.

Case in point.  Yesterday I got a call from Liberty Mutual, that manages my disability claim on behalf of the Evangelical Lutheran Church in America.  "I'm calling to inform you that your benefits have been suspended.  The reason why we are suspending your benefits is because your doctor has failed to submit the report we requested on time."  This came on a Friday afternoon.  My doctor doesn't work Fridays.  Frantically, I tried to get a message through to her.  If I can get her to submit the requested report by Tuesday everything will be alright.  If I don't get ahold of her until Monday, she'll have to drop everything to do the report (six months of treatment notes is what's being requested).

The point?  One of my diagnoses is an anxiety disorder.  The single most difficult thing to cope with during this time, given my diagnosis, has been the disability plan that is supposed to be helping at this time.  In the aftermath of the call I began having "partial complex seizures".  Great.  They're trying to determine whether I should remain on disability, and their methods of determining this are such that they aggravate the disease, and it could land me back in the hospital.  Which of course might answer their question.

Its things like this, difficult to cope with, that can cause deep seated anxieties and, yes, a rage.

Second case in point:  The message implied in much of the communication from the disablity claims department is 'prove to us you cannot work'.  On the other side of the equation, for me to be considered eligible for call, there would be the demand to 'prove to us you can work'.  It is at one and the same time in the best interests of the Church to get me off of disability, yet also, to not allow me to re-enter parish ministry.  The disability plan feels like a severance package and a disposal system.

Then twinges of rage start stirring deep within.

Then I step back, reflect on it, and wonder if such experiences that are common for a person with a mental health diagnosis, are the breeding ground for the type of rage that can lead to horrific behaviors?  For those who are Sesame Street fans, I find myself wondering if there is a monster at the end of this book, and if the monster could be me. . .

Scotch Double, Please.

I drank normally for most of my adult life.  Really.

Two beers was a typical limit.  And even that was occasional.  My typical pattern was to have beer in the refrigerator during the summer months and into the fall during football season, but often there would be no alcohol at all in the house, not by any intentional choice, but simply because I didn't bother to pick any up.  I mean really, 30 below zero, with a thirty mile an hour wind does not stimulate a desire to have a cold one.  I might have a glass of wine when we went out for dinner.  Pizza and beer was a good combination.  And when I would go to the pastor's convocation, I would sit with colleagues till closing, sharing a few pitcher's of beer.  This was the only time I would regularly become intoxicated, and that was only once a year.

When I was first diagnosed with depression, my psychiatrist told me I'd have to refrain from alcohol or else the treatments he could offer would be ineffective.  Alcohol is a depressant.  Taking both anti-depressant medications and drinking alcohol simultaneously simple doesn't work.  They counteract each other.  So I didn't drink.  No big deal.

What ended  up being a big deal was that the psychiatrist put me on an anti-anxiety drug called Ativan, or lorazapam, both for anxiety and to aid my sleep.  It is highly addictive.  A number of years later, feeling better, I decided it was time to go off my medications.  This was before I was diagnosed as being bipolar.  I was being treated for dysthymia at the time, a long term moderate depression, and so it was not untypical to come to a point where discontinuing medication was an option.  When I went off the Ativan, my doctor weaned me by putting me on half a dose for a few weeks, and then off.  I think he may have warned me about alcohol use, but I'm not sure about that.

What happened was that I immediately, as in overnight, began having a couple of scotch doubles per night to ease the anxiety and help with sleep.  Prior to this time, I had resumed drinking once a week, or so, rarely more.  A friend would come over on Wednesday nights, and we'd share a couple of drinks of scotch.  That's it.  Once a week.  Then, I stopped the Ativan and it was every night.

Having a couple of drinks per night is generally, socially acceptable.  And in the beginning it was not much of a problem.  At least I didn't think it was a problem.  In the beginning I didn't realize the extent to which I was dependent.  What I discovered later was that I had become chemically dependent on the Ativan, and then when I went off the Ativan, I experienced a "cross addiction" to alcohol.

I realized at one point that if I didn't drink, I couldn't sleep.  So I went to my physician an shared that I felt that I had become dependent on alcohol for sleep.  He put me on Ambien, which produced horrific nightmares.  Then Lunesta. When I went to fill the Lunesta prescription, my pharmacist informed me that Lunesta should not be taken nightly, because it is potentially addictive, habituating, and in the end, could cause significant liver damage.  "I wouldn't recommend using it anymore than once every three nights."  My solution was to alternate between the scotch and the Lunesta.  I preferred the scotch.

The thing was, it worked.  It did what I wanted it to do.  When my wife would raise concerns about my drinking, I would defend it by pointing out that whether it was scotch or Lunesta, the fact was that without help I could not sleep.  It was simply a matter of choice which drug I would use.

The problem is that alcohol is not only addictive, but habituating.  As time went on I needed more to achieve the desired effect.  My two scotch doubles (specifically 6 to 7 fluid ounces per night) became 3, (over 10 fluid  ounces) per night.  And that was the average.  I know this because I have a record of all my purchases of scotch.  I did my finances on Quicken and could look back and itemize every purchase at the Idaho Liquor Store.

What I now realize is that when I would cycle between hypomanic highs, and depression, my consumption would increase at both ends of the spectrum.  As my drinking increased, my tolerance level did as well.  I used to joke that it took two doubles just to feel sober.  It actually did.  There were three phases in my drinking.  First I drank because I liked the taste.  Then I drank for the effect, I liked the buzz.  And finally, I drank to feel normal -- that is to alleviate the symptoms of withdrawal.

Toward the end of my drinking this became quite pronounced.  I had decided I would not drink on Saturday nights because I didn't want my congregation to smell alcohol on me Sunday mornings.  On Sunday mornings I would shake to the point that I could not pour the wine from the pouring chalice anymore.  I thought it was stress.  Turns out that to avoid smelling of alcohol, I was actually detoxing in front of  my congregation each Sunday.

I reentered psychiatric care in 2012 and the psychiatrist put me back on Ativan, hoping I wouldn't need to drink as much.  It didn't work.  On my last night drinking, I was in a rage over some issues at work, trying to 'drink it away', and I decided I'd need the Ativan as well.  Not a good choice.  It nearly killed me.

Alcohol worked until it didn't.  Now it never will again.

Post Script on "Into Your Hands"

Quotable Quote from my first psychiatrist:
"The likelihood of your dying of a self-inflicted gunshot wound is much greater if you actually have a gun. . ."

Into Your Hands. . .

I am in a good place.  Don't call my doctor.  Don't worry.  But I write to share my experiences, now past, but which are a very real part of this disease.

"Into your hands I commend my spirit."

These words which Jesus spoke from the cross just prior to his death spoke to me on numerous occasions.  I contemplated speaking them myself, and with them, breathing my last as he had.  I didn't.

Its interesting to hear people talk about suicide and the judgments that are often rendered.  "Suicide is an unforgivable sin for there is never any chance for repentance."  "Suicide is such a selfish act."  "Suicide is the ultimate lack of faith."

All I can say to those who say, have said, and perhaps continue to say things like this, is that this has not been my experience.

"I haven't been suicidal," I have told my doctors, "but I can see it from here".  I know the feelings of despair and hopelessness that give rise to such thoughts.  The weariness.  Oh, the weariness.  How many times can you hope that a new medication, or counseling, or life changes will bring about healing, only to have those hopes shattered as the day to day grind of depression resumes?  How much of life can be endured during the dark lonely nights of despair before it is finally too much?

To those who would talk about "unforgivable sins" I'd suggest that it is more helpful to recognize the struggles of living with "incurable diseases".  To those who consider that suicide is a "selfish act" I would suggest that for one so burdened with mental illness there comes a point where the "self" is simply lost, destroyed by the disease, with no capacity for consideration of others.  And to those who would suggest that suicide is the ultimate lack of faith, I can only say that as I have contemplated those words "Into your hands I commend my spirit" it was not for lack of faith.

Sometimes the simplest things might be the most important things to remember as one struggles with suicide.  "Take two aspirin and call me in the morning."  Actually, to be serious, dead serious, (pun intended) the most helpful thing of all for me, and I believe many struggling with suicide is to have a reference in the future (hence 'call me in the morning').  Something concrete.  If I were living with someone who was struggling the way I have struggled I would try this simple thing.  Get out a daily planner.  Tomorrow we will go to dinner.  Friday, lets walk to the beach.  Lets talk to the doctor on Monday.  We're going to have eggs benedict in the morning. Next week we will spend some time with the kids.  You don't have to plan a trip around the world, but simply help to build a vision of tomorrow.

During those times when I have been borderline suicidal, it was because a massive curtain was being drawn that closed off all vision of a future.  People commit suicide not because they want to end their life, but because in their perception, there life has already ended. They simply cannot see the future. That is the tragedy.  Its just a perception.

There has got to be something, perhaps simple, but significant nevertheless that is coming, that can be anticipated, that will give reason to pause.  Today is not a good day to die.  The trick you see, is not dying now.  If somehow there is something, no matter how simple, to focus on then the thoughts of 'no tomorrow' will pass.  That's what I believe.

Today, I'm in a good place.  I do have hopes which sustain me.  There are frustrations.  I'm on yet another medication to aid sleep, and the results are mixed.  I've had some good night's sleep, and some nights where it was just more of the same.  But the depression is in check.

And I hope that it is never by my own choice that I utter those words "into your hands I commend my spirit" and then die.  But if you know someone, have loved someone, and grieve the loss of someone who "died by suicide" after a long battle with mental illness -- know that it was the disease that finally killed them.  Their life was taken from them, just as it would have been had they died of cancer.

Responding. . .

So a loved one has a mental illness diagnosis.  How do you respond?  What is helpful?  What response will be welcomed by those of us with a mental illness?

As one with a Bipolar II diagnosis, I wish I knew the answer to these questions.  Its not a simple matter.  At this moment, three things stand out.  Empathy, understanding, and perspective.

"I know how you are feeling."  Well, no, you probably don't.  But I'd sure like for you to try.  Empathy is the ability to understand and appreciate the feelings of another.  This is possible because we are not unique.  We have much in common.  No, in all likelihood you are not Bipolar, nor have you had those experiences and feelings.  That said, even 'normal' people experience the ups and downs of life, We've all experience times of feeling depressed, or experiencing an emotional high.  Its just that with someone who is Bipolar, those cycles are much more pronounced, uncontrollable, and frightening.  Imagine, for example, what it is like to be feeling quite normal, life is good, everything is manageable, and then to be thrown off a cliff.  All it takes is a few words, a bad experience, or nothing at all, and then over the cliff and into the abyss I go.  The frightening thing, is I never know where the bottom is.  Or imagine living each day, knowing that as evening approaches, depression will roll in like the San Francisco fog.  Or imagine what it feels like to believe that life is full of opportunities, everything is achievable, and great things are possible.  There is something exhilarating about being on the top of the mountain.  Can you imagine that?  And then imagine being locked on a roller coaster, and being subject to these ups and downs, uncontrollably, and you can't get off.  If you're normal, you won't experience to totality of life the way one who is Bipolar experiences it, and yet you do experience, at some level, the individual pieces of that.  Draw from that experience and seek on that basis to empathize with what we are experiencing.

Understanding.  It is helpful for those who deal with someone who is Bipolar to make the effort to understand the condition.  For example, the mood swings are both physiological and psychological in nature, or so my counselor says.  And the two are interrelated.  Sometimes I feel the way I feel because, and only because, of the particularities of my brain chemistry on that day.  "Is something wrong?"  Well, yes, and no.  Yes, I'm feeling deeply depressed today, but no, nothing has happened out of the ordinary.  I just feel depressed.  Another day it is quite possible that an event, a comment, a personal interaction, a positive or negative development, has resulted in the mood shift.  Understanding.  I don't feel the way I feel because of what I've done.  I do what I do because of the way I feel.  Understanding.

And then there is a wonderful gift that you can offer to someone who is Bipolar, especially during the manic phases of the disease, and that is perspective.  And yet tread lightly here, it is extremely angering to be dismissed categorically, because "its the mania talking."  Having said that though, it is often helpful to have the perspective of a normal person guiding me.  The more I understand the peculiarities of this disease, the less confidence I have in my own judgement.  "I used to really enjoy fishing.  Maybe I'd feel better if I started fishing again.  Yes, that is it.  Now I'm excited.  I think that to make the most of it, I'll buy a new fishing boat.  Yes, it's more than we can afford, but I'll make it work.  It'll be money well spent, if it makes me feel better, and I know it will, because the thought of it already is making me excited!"  At this point, perspective is indeed helpful.  It's not that a new boat is necessarily a bad thing.  But it would be a better thing if the decision is made based on something a little more grounded than the mood we are experiencing.

But tread lightly here.  The last thing I want to be told is that I'll never be able to buy a boat.  I don't want every 'great idea' I have vetoed because I'm Bipolar.  The gift of perspective though, is to offer assistance making a few judgments.  Is this a reasonable choice given the realities of our life?  Or is this just a mood driven desire?  Perspective is to assist one to make life choices with one's feet firmly grounded in reality, not mood.  This is a gift that can be given.

Savior's a Nuisance. . .

A savior's a nuisance to live with at home,

Stars often fall, heros go unsung,

And martyrs most certainly die too young.

(Joan Baez, "Winds of the Old Days")

What's the narrative of your life?  This was the question my counselor asked yesterday.  What's the narrative?  How do you make sense of it all?  What's the story line.  I recoiled at the question.

"That somehow, through all the suffering, through all the ups and downs, there might be some redemptive value to it all."  "No matter how far down the scale we have gone, we will see how our experience can benefit others."  (AA promises)  Wounded healer.  That others might somehow be helped by my sharing my story.

There is a significant burden to the compulsion to be a 'savior'.  And the quest for meaning and purpose in a life riddled with ups and downs is illusive.  "At least there was a redemptive purpose to Jesus suffering."  Its the search for a redemptive purpose that drives the hypo-manic phases of my life.  In spite of the "nuisance", there is this desire deep within me to change the world.  Perhaps it is born out of a sense of helplessness to change myself.  At least if some good comes out of it, then I can live with it.  A star is born, headlining my own drama.  A hero arises out of life's long suffering battles.  

But stars often fall, heros go unsung.  During times of depression I find myself overwhelmed by the meaninglessness of it all.  There is no purpose.  A life wasted.  It didn't have to be like this.  "Would it spoil some vast eternal plan, if I were a wealthy healthy man!"

Ah, but contentment takes the edge off of creativity.  "Were it not for depression we would never have had a Hemingway.  Of course, were it not for depression we might have had Hemingway a bit longer."  (comments of a colleague)  Perhaps its that tension between being a savior and meaningless suffering that is the catalyst for movement and purpose.  That I suppose is the narrative of my life.

Heart surgery was easy. . .

It is 4 am.  I awoke this morning before 1 am.  After trying numerous times to get back to sleep, I gave up and am starting my day.  I return to my blog. . .

In 2002, on December 29th, my twenty fifth wedding anniversary, I ended up in the emergency room as a result of a major gastro-intestinal event. During the course of the examination the doctor remarked "Has anyone ever told you that you have a heart murmer."  "No."  "You better get that checked out."

Turns out I had a mitral valve prolapse, and was scheduled for surgery that spring.  I did my research and discovered that the surgery was being performed with a surgical robot, and found a doctor that was willing to do it that way.  I ended up being the first surgery in Spokane using this technique.  I checked into the hospital early Wednesday morning.  The surgery lasted a long time and it was late in the evening that I began to awake.  However, because the whole surgery was performed though a series of 1/2 inch incisions the recovery was almost instantaneous.  By morning I was walking around the floor.  I was discharged from the hospital on Friday.  My doctor asked that I remain in Spokane over the weekend.  On Saturday the kids came to visit and we spent the day walking around Riverside Park and riding a four person bicycle car.  When I got home to Sandpoint on Monday, I had a funeral for a young child who had died while I was in the hospital, and I resumed a full work schedule.  Open heart surgery had been a piece of cake.

 It is amazing to me that I could undergo heart surgery on Wednesday, be riding a bike on Saturday, and back to work on Monday.  And yet after nearly two decades of treatment, I still cannot sleep.

"I can knock you out."  my doctor said.  The problem is to find a medication that will enable a healthy sleep cycle, and that is sustainable.  At one point, fearing that I had become dependent on alcohol for sleep (I had) I asked my doctor for an alternative.  I was prescribed a sleep medication.  When I went to the pharmacy to have the prescription filled, the pharmacist took me aside to emphasize that I should only take the medication once every three days or so.  If I took it everyday, I would become habituated to it and it would no longer work (at least without increasing the dose beyond what was appropriate).  Furthermore, there was a risk of addiction.  Not to mention that it also carried a risk of liver damage.

So I was faced with two choices.  I could take the medication that was habituating, addictive, and caused liver damage, or, I could drink alcohol which is habituating, addictive, and causes liver damage.  I began taking the medication one night, and drinking two nights, which at least reduced my alcohol consumption by 1/3.  When my wife would complain about my alcohol consumption I would be quick to point out that my choice was not whether or not to use drugs to sleep -- it was simply a choice of which drugs to use.

After undergoing treatment for chemical dependency, my doctor has been very committed to prescribing only medications that are non-addictive.  This has severely limited the choices.  Basically, almost all of the sleep medications are potentially addictive and so we've been using other drugs such as anti-depressants that have a side effect of making one drowsy.  This has had the effect of enabling me to go to sleep.  Staying asleep is the problem.  We changed meds this last week to see if we could find a more effective treatment.  It is worse.

Less than a week after open heart surgery I was going full speed.
Two decades of treatment for insomnia has been ineffective.
Something just doesn't seem right about that.

The hardest thing about this whole experience is fighting off the urge the think that a full night's sleep is only a couple of drinks away.  The last time I tried that I nearly entered into "eternal rest" which is an entirely different problem than waking up too early. . .