No Justification. Not even the economy.

160 years ago slavery, and the overt racism behind it, was justified on the basis of the economy.  And violence against those who would change it was justified.  The Bible was used to justify it. 

Not much has changed.  We have a president who, while claiming he is not racist, lambasts the country with one racist thing after another.  David Duke and other white supremacists see this.  They love it.  People who are Muslim, or Hispanic, or Black feel this.  Crowds at political rallies chant "Send them back!".  Racist.  By the way, sending  minorities back to their country of origin is a central theme of the Aryan Nations.  White, Christian, Nationalism is just a contemporary manifestation of the basic tenets of the white supremacist agenda.  The Church of Jesus Christ Christian is what the Aryan Nations under Richard Butler belonged to.  As a country we should abhor all this, reject it, and work to overcome it.  Racism has no place in a free society.  Racism is sinful.  White Christian Nationalism, if it is not checked, may well destroy both the Church and the Nation.  It is that contrary to both democracy and freedom, as well as the message of Jesus Christ. 

But the economy is good.

The economy was good for slave owners in the South.  It did not justify slavery.  Hitler's rise to power in Germany was closely associated with economic recovery from the Great Depression and the consequences of the Treaty of Versailles.  Bottom line was that Hitler was 'good for the economy'.  That hardly justified the Holocaust. 

Two things are reprehensible about the current state of affairs.  That otherwise good people will continue to support Trump, in spite of his racists attacks, is one of them.  That otherwise good people will oppose any effort to control access to guns as a means of responding to the myriad of mass shootings in our country is another.  And in the most recent shooting in El Paso the two issues are married together. 

But the economy is good.  And we like to collect guns.  So to hell with the loss of life.  We're content to send our "thoughts and prayers".  I can't help but believe that God despises our 'thoughts and prayers'. 

But the economy is good.

Except if you're a farmer or any other of the people affected by Trump's trade wars.

But we don't much care about other people's economic plight.  The economy wasn't good for the slaves in the South.  Just the plantation owners. 

There is no moral justification for racism.  There is no moral justification for callused indifference to the loss of human life.  There is no moral justification for caring more for the economy than the lives and well being of human beings.  No Justification.  None.

I struggle with how to respond.  I live in North Idaho.  Trump is popular here.   Racism is common place.  Guns are BIG.  I tend to politely, quietly, often silently, disagree.  And in doing so I'm part of the problem. 

I have to work with these people, whether in the cabinet shop or when I reopen my own business.  And I hesitate to address the issue head on in my preaching or teaching at church, lest the offerings tank. 

But economic considerations are no justification for doing nothing. 

I can become politically active.  The struggle is that in Idaho, my voice is drowned out by the vast majority in this redder than red state.  My vote counts not at all, except as a protest.  And there is a reason white supremacists have chosen to settle here: racism is widely accepted in this predominantly white society. 

But at least the economy is good. 

Biodiversity, Conformity, and the Church

If there is anything we can learn about God from creation, it is that the Creator had incredible imagination and loved diversity.  The world is filled with mind boggling complexity, millions of different expressions of the Creator's concept of life, and an ever changing and evolving universe.  Sometimes we contribute to the diversity of creation.  Think of the many different breeds of dogs that we have developed.  But we've also been prone to do things like settle in on one variety of wheat, of corn, etc., and global conformity.  We are starting to learn our lessons about the pitfalls of this, but slowly.

And then there are humans and our limited capacity to deal with diversity.  Bananas.  1,000 different varieties of bananas and we prefer to have only one, the Cavendish, available in our stores.  Why?  I suppose its because we simply want to know what to expect.  There are all sorts of examples of this tendency of humans.  We gravitate towards McDonalds, not local diners with a varied menu.  "Bud Light, for the many not the few."  Cultural norms and expectations limit the scope of our uniqueness.  We like to know what to expect and so we push conformity.  As humans interact, rather than increasing in our biodiversity we tend to allow a dominant culture to emerge and to overwhelm the various regional, ethnic, and cultural differences.  The American experiment is especially telling.  With immigrants from every continent we pushed an anglicized uniformity.  Speak English.  Melt into one.  Do the American thing. And then watch as "Westernization transforms cultures throughout the world."  Chinese people wearing blue jeans.  And Starbucks is opening 3,000 new stores there.

And then there is the church.  One, holy, catholic, and apostolic church.  Doctrinal conformity.  Inculturation.  Should the church be transformed by the variety of cultures in which it is present or should the church transform those cultures toward a unified expression?  We haven't done so well with cultural diversity.  And when diversity divided the church we saw that as a curse, not a blessing.  The single largest question in this regard is whether it was God's will that humans express their religious inclination in a uniform way, or whether God intended from the beginning for our spiritual lives to be a diverse as our physical and mental tendencies.

How do we deal with anomalies?  You know, those deviations from the norm.  "Deviant" is a negative word.  I'm bipolar.  What that means is that my capacity for mood swings from highs to lows exceeds the norm.  My highs are higher.  My lows are lower.  My medication is designed to eliminate that and achieve a culturally acceptable middle ground.  Are variations from the norm a disease or God's diversity coming into play?  Good question.

Sexuallity.  How often have we tried to force a spectrum of expressions into a culturally defined and rigidly maintained duality.  Its just not quite as simple as "male and female he created them".  Ironic that the Creation story that details the vast diversity of God's creation is used to force a compliance with cultural norms and a condemnation of deviation from those norms.  Again, "deviant sexual behavior" is used to condemn.  This in spite of the fact that we, as humans, exhibit "diverse sexual expressions".  We struggle to understand.  "LGBTQ" is an evolving expression.  We're not even always sure what those letters stand for, or how many variants are present within them.

I'm not into 'anything goes'.  Child abuse, whether physically, sexually, or mentally is always immoral and should be severely punished in my mind.  But what is abusive, and what is nurturing?  By the way, I'm not much into abusing adults either. . .

It's all so mind boggling.  Hence we tend to settle in on normative behaviors and discourage variations from the norms.  And God is used to enforce those norms.

I love my church, but I deeply regret its lack of diversity.  We are the whitest denomination in the United States.  We set a goal to become a church with a minimum of 10% people of color or whose primary language is other than English.  That was 1988.  The only significant change in color of our church since then has been the greying of our hair.  Fact is that we are not the church catholic.  We can only become an inclusive, diverse, church through ecumenical work.  And an ecumenism that celebrates diversity, not one that seeks uniformity.

I am convinced that there is a reason God created platypuses.  Perhaps just for the shear delight in it.  And not every bird should be a bald eagle, as majestic as that bird is.  And the thought that one day, through generations of interracial marriage we will emerge as a unified race is appalling to me.  What I hope for is an appreciation of diversity.  Deviation from the norm is the norm, by the way.  And God said it all is good.

A Lament

Why, Oh Lord?  Why?

When one's life is already mostly lived a diagnosis of mental illness is not welcome, but at the same time, not so overwhelming. 

But for one whose life is still yet to come such a diagnosis is a burden that will be carried so long.  Why, Oh Lord?

Yet, there is also hope that rather than muddling through life without the help available, such a young person, armed with a diagnosis and empowered with a proper treatment plan will be able to reclaim the potential of their life.  The chemical malfunctions of psychiatric disorders can be addressed, and alleviated.  And yet, such a diagnosis early in life carries with it the burden of a lifetime adjustment, not to mention the expense of a lifetime on medications. 

The tragedy of such an early diagnosis is that at a stage in life when identity is being formed, a diagnosis will take center stage.  Bipolar, OCD, Schizophrenic, paranoid, depressed, whatever-- these are not the pillars around which one wants to establish their identity.  It's different when one has already established that identity and is firmly grounded.  Such a diagnosis later in life is difficult, but it is easier to maintain an identity independent of the disease.  When one is young and just coming to terms with the 'who' of who they are, such a label carries a louder voice.

It presents other challenges.  That quest to find a lifetime partner just became even more challenging.  "Hi, I'm Jane, an Aquarius, I love the beach, and dogs, and have a passion for music and dance.  I'm also a paranoid schizophrenic.  Would you like to hang out and have a cup of coffee?"  In selecting a mate, some will not have a problem with one who is mentally ill.  But if we are honest, many will have a problem with that.  It's like drug addiction.  Many marriages have survived chemical dependency and the subsequent treatment but, given the choice, would you prefer to be with one who will face those challenges or one who is healthy? 

Back to the matter of identity.  Establishing an identity, one's personhood, is such an integral part of adolescence and young adulthood..  Now there is the disease that is part of that.  But there is more.  Medication and its affects.  Is the person I am today really me?  To what extent are my experiences now attributed to a medication as opposed to my true self? 

Is a thought I have my own?  Or is it a symptom of a disease?  Or is it skewed by medication?  Have the medications resulted in my now reconnecting with my true being?  Or have they created an alternative reality with which I now must live?  Who am I?  Can I even claim my own thoughts?

Thief!  Demon!  Who gave you the right to take up residence in my soul?  Was it God?  Or heredity?  Or simply being the wrong place at the wrong time?  What opportunity did you seize Satan?  Be gone.  And whatever happened to the exorcists that we desperately need in the face of these demons?

And vocation.  Choices are now limited.  OCD in small doses makes for good doctors and nurses.  But when the paralysis rooted in fear prevents one from acting, not so much. 

Life goes on.  There is a lot of life left to live.  And with diligence, treatment can be successful.  Opportunities may open up again.  It is not over.  Don't punctuate the end of the sentence just yet.  Let the diagnosis be at best, a comma.  Not a period.

Why are they doing this to me, Oh God.  Why are you allowing this to happen?  Do you even exist?

A roomate, diagnosed with schizophrenia, once observed that there are a high proportion of schizophrenics that are atheist.  It's hard to believe in a God who simply flunked chemistry. 

Or we can believe and bring our lament to the Lord.  We can plead our case before the almighty and hope for grace in the time of our need.  And strain to see light at the end of the tunnel.

Such is the plight of the mentally ill, especially those who are so young.  God be with them.

Two Questions

One of the things our health insurance plan has is a nurse case manager to assist regarding our health issues and so I was contacted after being discharged from the hospital following surgery.  I have to admit I'm a bit sceptical of the benevolent nature of such calls, as they come from the insurer.  I rather anticipate that the outcome is some suggestion to limit costs.

And actually, there was one such suggestion.  I was asked what I would do if I experienced complications after hours.  My immediate response was that I'd go into the emergency room.  The nurse quickly pointed out that I should call the doctor's office and likely they'd have an after hours number to refer me to.  Cost savings.  (I don't know if such a number exists, but I would check.)

But mostly what the consulting nurse did was to review my case, ask pertinent questions, and otherwise inquire how I was doing.  We also reviewed my overall health history, and the  medications I am currently on.  She inquired whether I had any difficulty getting those medications.  I shared that I had some difficulty getting Rozerum, a sleep medication, and went on to explain that because I have a chonic sleep disorder we were using Rozerum because it is one of the only sleep medications that is non-addictive and safe for extended use.

At the conclusion of the interview there were two questions left.  "Have you become less interested in activities that you used to enjoy?"  "Do you feel down and depressed?" This most basic of mental health screenings was welcome.  I expressed my appreciation for the questions, explained that as a bipolar person I am well aware of the signs of depression, but that no, I was not feeling depressed at this time.

Mental health screenings-- they should be more prevalent.  They should be part of every comprehensive 'physical', and to an extent, all medical examinations.  I say that because often the mentally ill first seek professional help for physical issues that are related to mental illness.  The tendency is to treat the symptom, but overlook the problem.

My chronic insomnia is one such issue.  I remember one visit with my primary care physician in which I shared that I was concerned that I had become dependent on alcohol for sleep.  I was adamant that I could chose not to drink, its just that I didn't sleep well if I didn't drink.  OK, well there are a number of red flags there.  My doctor prescribed a sleep medication, first Ambien (which produced nightmares) and then Lunesta, which worked better.  Unfortunately, there were issues that were not discussed that should have been.

"If you are dependent on alcohol for sleep, you are chemically dependent."  That should have been pointed out to me.  I wouldn't have wanted to hear it.  But the truth is that I was in the early  stages of my alcoholism.  This was most evident in that when I was given the sleep medication, I still relied consistently on the alcohol as well.  My pharmacist, unfortunately, told me that Lunesta was habituating, and potentially harmful to my liver if I used it every night.  It would be best, he said, to only use it when I needed it, perhaps 1 out of 3 nights.  If I used it every night, it would lose it's effectiveness.  1 out of 3 nights.  Ok, then, I had a solution for the other two nights.  Scotch.

Another issue is that insomnia is often a symptom of deeper issues.  For me, it is and has been the most enduring symptom of being bipolar.  Unlike some, I don't sleep away my depression.  I am more likely to experience sleep deprivation, both when depressed, and when in manic phases.  The only difference is that my sleepless nights are more productive when I'm manic than when I'm depressed.  My experience of this is such, that I'd recommend a full psychiatric evaluation for anyone that seeks out treatment for insomnia.  If you cannot sleep, SOMETHING is going on.  Normal people can, in fact, sleep.

Actually, when I was first diagnosed with depression/insomnia, the physician decided to treat the sleep disorder in the hopes that if I could sleep better, the depression might subside.  I was given Ativan, an anti-anxiety medication for sleep.  It worked.  Unfortunately, Ativan is addictive in its own right and paved the way for my alcoholism.  Alas. . .

It all boils down to this.  Mentally ill people are most likely to first seek help because of another issue that is a symptom of their mental illness but not for the mental illness itself.  Mental illness tends to hide behind other health concerns.  Weight gain or loss.  Ask the question why?  (I lose weight when depressed, others gain.)  Can't sleep?  Why?  Loss of appetite?  Why?  The list could go on and on.  That's why health screenings for mental illness are so essential.  And we need to remember that mental illness is a potentially fatal disease.  Fatal.

This last week I was diagnosed with a bowel obstruction that turned out to be the result of a strangulated hernia within my abdomen.  I've since learned that those conditions are potentially fatal if not treated in a timely manner.  Hence, my surgery on a Sunday afternoon.

It is also necessary to recognize that a timely response to mental illness may be critical to insuring that the condition does not become fatal.  Its that important.

Say what?

"According to my notes from Dr. Hayes, you are neurotic, yes?"

Ok, I wasn't expecting to hear those words.  "Neurotic" doesn't sound good, rhymes with "psychotic", and besides, why is this new psychologist making such pronouncements when he is first getting to know me?  Well, because that's what he's paid to do, I suppose.  So I went home and looked up the definition.

Neurosis:  a relatively mild mental illness that is not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behavior, hypochondria) but not a radical loss of touch with reality (which would be psychotic) .

What I also found out was that this is a general category that is no longer in widespread use by the psychiatric community.  There are some things I agree with, other things I don't.  I've never lost touch with reality.  That I agree with.  "Mild mental illness"?  When one is so depressed that getting off the couch is a challenge, that suicide seems reasonable, one would not describe that as "relatively mild".  "Not caused by organic disease?"  My understanding of being bipolar is that it is indeed organic, having to do with certain imbalances in the chemistry of one's brain, and not just a symptom of stress.

So, I'll talk with the doctor about his next time.

Mental health diagnosis is often, it seems, a judgment call.  Psychiatrists and psychologists often argue amongst themselves.  Some are more prone to certain diagnoses, others see such conditions as much less common.  I'm confident in my diagnosis of Bipolar Disorder.  The reason is that my depression did not respond to antidepressants, but did respond to mood stabilizers.  Bingo.  That's Bipolar.

But even within that, Bipolar I or II remains a judgment call.  It has to do with the degree to which one has experienced manic episodes.  What are the symptoms?

"In order for a manic episode to be diagnosed, three (3) or more of the following symptoms must be present:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Attention is easily drawn to unimportant or irrelevant items
• Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)"

There are other less technical associations, such as being delusional, or losing touch with reality, but that's not actually on the list.  Though "inflated" is a bit out of touch with reality.  As is "grandiosity".  

One of the struggles with an exact diagnosis is that during a manic episode one feels good and often doesn't seek help, though others may recognize that things are getting out of control if they know what to look for.  My last manic episode was shortly after going through chemical dependency treatment.  I resigned my call and went into business, spending about $60,000 in the process, I took over my therapy sessions and had my psychologist simply listen as I did my 'fifth step', etc.  My feeling great at that time was credited in part to the 'blue cloud' of recovery, of getting my life back on track, etc.  And the diagnosis of being Bipolar had not yet been made.  Had my health team been looking for signs of mania, they would have recognized it.  Bottom line, one of the difficulties in making an exact diagnosis is that they have not directly witnessed a full blown manic episode.  

But also, I believe, is the fact that the difference between mania and hypomania is really a matter of degree and not type.  

"You're somewhat egotistical."  That was also in the notes.  Truth is that depends on whether I'm in a manic phase or a depressed phase.  When I'm manic, I'm prone to believe I'm one of the best pastors in the ELCA.  On the other hand, when depressed I feel like a total failure, and that everything was for naught.  To an extent, both beliefs are delusional.  Out of touch with reality?  Well, yes, I'm neither the best nor the worst.  Reality is somewhere in between that.  

I look forward to working with a new therapist.  Maybe some new insights will be helpful.  Among other things he talks more.  And maybe I need to listen more.  

Humility, Gratitude, and the Depth of Love

One of the thing I remember about growing up was the care packages we received from our extended family.  In particular, I remember one package that contained some pants for me.  My aunt and uncle, recognizing that our pastor's family often struggled to get by on the salary our church provided, had sent a box of hand-me-down clothes.  Only one problem, my cousin David was short and stocky, I was tall and skinny.  The pants I received were the correct length, but required a substantial, and I mean substantial, tuck to be taken in the waste line for me to wear.  The fit was such that my friends initially thought I had the first bell bottom pants in the school.  All that aside, our need was real, and the graciousness of the Michaelson's to recognize that need and offer their assistance was generous, and, underlying it was a depth of love.

Fast forward half a century.

Dammit, I'd like to be entirely self sufficient.  Pride can itself be a debilitating thing.  The truth is that all that has happened with my disability, with the change in my employment status, with medical bills, with coping with the challenges of life itself has left me in the position of either needing to recognize the need for help, and accept what help is available-- or to sink.

It's one thing to preach about Jesus Christ as being the Savior of the world.  It's quite another to admit I need a savior.

I'd rather be the savior.  This is particularly true of my manic side.  I've had some opportunities over the years to be the savior.  For example, when my daughter faced the challenge of student teaching.  Substantial tuition, little financial aid, a requirement that she not work outside of student teaching, oh, and a car that went belly up in the midst of it all left her needing some help.  "Daddy finance" came into play.  The total of those expenses tallied up to more than my gross income for that period, but I found a way.  I know it was hard for her to admit she needed help, and she was deeply grateful for the help that came.  There was another dimension of it, and that was the opportunity it gave me to act in love.

Ministry also offered me the opportunity to 'save' people from time to time.  Intervening in situations of spousal abuse, channeling donations to those in need, helping people negotiate the difficult decisions of life and death-- and many more examples.  It feels good to be the savior.

It's quite another thing to admit one needs a savior.

The last five and a half years have been humbling in that regard.  And I'm deeply grateful for the assistance that has been offered to me and my family.  But most of all, I'm overwhelmed by the depth of love that has been shown to us, through this whole set of circumstances.

The last night my father was alive we had a wonderful conversation.  At the end of it, as we each expressed our desire to have many more conversations like this, I apologized.  My work schedule had severely limited the amount of time I had to spend with dad, even though he lived with us.  "But," I told him, "at least its keeping the bills paid."  His response, and the last words he spoke to me, was "Well, my hope is that my being here will take some of the burden off you."  One of the beautiful things about Dad coming to live with us was that we could help him, and he was able to help us.

When I first entered the ministry, and was at Thompson Falls, the congregation was unable to meet expenses and pay my salary.  Recognizing our predicament, Mom and Dad joined our congregation even though it meant driving 75 miles to attend church, and became the largest contributors.  Dad was overjoyed that I had become a pastor but also was deeply aware, because of his own experience, of the financial challenges we would face.  Both he and mom tried to help as they could.

As I faced disability, unemployment, and all that went with it, he was concerned.  Dad realized that our financial challenges were far greater than those of my other siblings.  Each of them, and their spouses, had done well in professions that paid much more than pastoral ministry.  Dad was concerned for us.

What I found out this last week was that Dad asked one of my siblings to make sure that we'd be alright after he was gone.  I was emotionally overwhelmed when I found out about that.  Tears come to my eyes as I write this.

This would be 'touching' in many circumstances.  When the reality is that we have indeed needed help, and need help, it is moving to the depth of my soul.  I am grateful.  I feel loved and cared for.

I don't know where we'd be if it weren't for such love and care.  It has come to us from a variety of people in a variety of ways.  Even when we couldn't meet the challenges that presented themselves, others have stepped up to help.  Humility.  Gratitude. And allowing people to show their love in concrete ways.

To be on the receiving end of loving care is a blessed thing.  It is to experience grace.

I wouldn't understand or appreciate God's grace nearly as much without these experiences of grace shown to me.  When everything is going wonderfully well, we don't need grace.  We can make it on our own.  At the risk of overstating my case, it seems to me that unless we experience the need for grace, we will never appreciate the gift of grace.

Today, I am grateful.  For grace.  For love.  And for the people God has surrounded us with.

There but for the grace of God. . .

It pains me everytime that the issue of mental illness comes up with regards to a shooter in a violent crime.  This last week it hit close to home, literally, as a gunman opened fire on two officers just a few blocks from our home.  The officers were both struck twice, though will recover fully.  The gunman was killed in the exchange of fire.

It is reported that he was a depressed and deeply troubled young man.  He had gotten ahold of his grandfather's gun, and his erratic behavior raised the concern of  his family, who called 911.  The arrival of the law enforcement officers triggered a flurry of gunfire.  Two wounded.  One dead.  Its not the way interventions are supposed to go.

My psychologist related yesterday that law enforcement personnel frequently intervene in such situations, and the vast majority of times are able to successfully bring in the person for treatment.

And yet I do find myself wondering if it wouldn't be better to respond first with EMTs or some other personnel than uniformed (and armed) police officers.  I am convinced that in some situations the mere presence of law enforcement can escalate a situation to the point where everything is out of control.

This much I know from my personal experience.  Brain chemistry matters.  And alcohol is certainly no help.

And probably most concerning of all is the reality that there is often an anger lying deep within one who has struggled with mental illness.  "Depression is anger turned inward." is one statement I've heard.  The isolation one experiences during mental illness, the lack of understanding, perceived or real, and the sense that it's "me against the world" can all lead to a deep well of anger within.

Rage.  A violent uncontrolled anger.  I've felt it.  I've struggled against it.  And in my darkest moment I nearly died trying to drowned it in a bottle of Scotch.  That night in particular, in the midst of all the ugliness and rage, grace abounded.  Karla kept her distance, yet didn't abandon me though she had every reason to.  A moment of sanity during a prior episode of drinking a few months earlier had resulted in my requesting my dearest friends to remove the guns from my home.

Rage is never the result of an isolated incident.  A lifetime of internalizing emotions, of seeking to silence the beast, results in a pressure cooker welling up inside one's soul.  It was only a matter of time.  My best friend was also my worst enemy.  I had been guilty of trying to drink the anger away for too long, because it never goes away.  And yet when you feel that rage within you are frightened.  There's not much one can do to remedy it, except for 'nature's cure' as I called it.

What would have happened had those nearest and dearest to me called in the wrong type of help in that moment?  It felt as though the whole world was an adversary, a threat, and that I had to mount my defenses against the onslaught.  Desperation.  Ironically, my drinking that night, though it nearly killed me, at least rendered me impotent after a while.  I went from a raging beast to a passed out drunk.  The latter was easier to help, in the end.  No police required.  Just my wife.  Some friends.  A bishop.  A psychiatrist.  And admission the next day to the hospital.

The rage continued for a few more days until I was broken down.  God intervened.

I'm deeply concerned about the widespread presence of guns in our society for good, personal reasons.  It would have been too easy.  It would have been too easy to turn a gun against myself.  It would have been too easy to pick up the weapon in a valiant, though insane, effort to defeat the perceived adversaries.

I don't know how I would have responded if I had answered the doorbell, packing heat, and discovered the police outside.  I simply don't know.  A raging bull is hard to predict.

What I do know is that I needed medical and psychiatric intervention, in addition to chemical dependency treatment. .  . and I needed it now.  I had been calling for help.  My bishop was the one who had first responded, actually, the day before.  I wish I had calmed down then, but the crisis did not abate at that point.

In hindsight, one of the things that still amazes me is the amount of time a psychiatrist in Seattle gave the following day as he arranged for my admission to a treatment center.  I had seen him previously so I was a patient.  But clearly he recognized that this was not a time to schedule a future appointment.  The healthcare system did not fail me during that moment.  I got the help I needed, even though I didn't fully want it.

Back to our shooter.  He didn't.  A gun.  Two police officers who he obviously thought a threat to him.  Two wounded, and one dead.

There but for the grace of God, go I.  There but for the grace of God, go I.

It didn't have to end like that.  In my case, a different script played out. Would that it was always so.  Would that it was always so.

Disability, Justice, and Prudence

Dealing with being mentally ill, and dealing with the mentally ill, is difficult.  There are no easy answers.  Life is filled with compromises.  And its hard to know exactly what is the appropriate response.

Disability.  I was fortunate to be covered under a good disability plan when I hit my crisis point.  I ended up receiving benefits for approximately two years, which gave me a window of opportunity to devote myself entirely to the healing process.  The only major complaint I had regarding that plan and the way it was administered was with respect to the way they terminated the benefits, basically without notice and retroactive.  I received my monthly payment, and then ten days later received notice that I would receive no more.  Little opportunity to make changes.  But we survived.

One of the questions I struggle with is the degree to which being bipolar remains a disabling condition.  Does the 'potential' of manic or depressed episodes constitute an impediment for employment?  One of the struggles with dealing with the disability plan is they loved to ask the question "How are you doing right now?"  Well, even while actively cycling between mania and depression, there can be a lot of time that one is within the normal spectrum of moods.  Employers, though, are not content with someone who is able to function normally MOST of the time.  

Risk.  And triggers.  My biggest concern about returning to the workforce had to do with the possibility that the stress of work might trigger a manic phase.  Two of the potential symptoms identified with mania are

• Increase in goal-directed activity (either socially, at work or school; or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

There's that word.  Sex.  Sexual misconduct is the cardinal sin of being a pastor.  And there is the potential for it in a manic episode.  I became convinced that as I was being evaluated for return to the active ministry that my health care team was intentionally not making a recommendation lest they incur liability in the event of a manic episode involving some sort of misconduct.  And I genuinely wondered if it was wise or prudent for the Church to allow someone who is bipolar to be a pastor given the fact that manic episodes may involve sexual indiscretions.  Fair question.

But is it just?  People who own guns are more likely to shoot someone than people who do not have a gun.  But would we deny employment to a person solely on the basis that they possess a gun and hence the ability to shoot someone?  (I think about this in part because there are numerous individuals who bring their firearms to work everyday at the cabinet shop where I'm employed.)  The answer is that we rarely discriminate against someone purely on the basis of the potential for a particular behavior.

I posed the question to the former assistant to the Bishop of our synod who handles candidacy, and his response was straight forward.  "Would you approve a bipolar person for candidacy?"  "I would simply ask 'Are you under a doctor's care?', and if you are, there is no problem."

But there remains the question of prudence.  It is probably good to be somewhat cautious.  But when does caution give way to prejudice and injustice.  Given the choice of two candidates, similarly qualified, would a congregation show a prejudice against the candidate who is bipolar?  In many cases, yes.  That's reality.

And yet a certain degree of caution is in order.  One of the thoughts I have had regarding my future in the ordained ministry is that I should seek out an opportunity to serve as part of a team, under the direction of the lead pastor.  This would allow me to serve as I am able, but have the safety net of the ongoing direction of the lead pastor that would tend to preclude my heading in an unhealthy direction because of my disease.  Not a lot of opportunity for that within our synod, but its a thought.

I am deeply grateful for the small congregation I do serve at the current time.  There are questions regarding how long this relationship is viable, but they have to do with the congregation's situation not my own.  This congregation has a history of supporting a pastor through significant personal and familial issues.  They welcomed me with the words "Your health is not a matter of our concern."  I count my blessings.  

As I struggle with these issues, and in the name of mental health awareness, let me make three important observations:

1. A mental health diagnosis may be disabling, but often is not.  People who are mentally ill and significantly impaired in their ability to function should qualify for disability benefits.  People who are mentally ill but still able to function should not be disqualified for employment.  Too often, I fear, mentally ill people are considered just functional enough to not qualify for disability benefits, but not functional enough to qualify for employment.  
2. It is just to discriminate on the basis of actual behaviors.  But, especially for one who is in treatment, discriminating against a mentally ill person on the basis of potential behaviors, symptoms that are under control through treatment, is unjust.  
3. Caution and awareness is the safety net for both the mentally ill person and the employer.  As I've said many times, if I propose something with a price tag of over a million dollars, ask questions.  That's reasonable.

I am not what uninformed people think.  I'll admit my own past prejudice here.  Ignorance of mental health issues often results in judgments being made that are not fair.  I've made those judgments.  You likely have too.  And then I had to confront the reality of who I am as a bipolar person.  That's different than a prejudiced imagination.  

My deepest wish is that we might proceed to the point as a society that a mentally ill person would only have to deal with the diagnosis and treatment of the disease, and not with a social stigma attached to that disease.  Life is difficult enough as it is, let's not add insult to injury.

Then, now, and always an alcoholic

I wasn't always an alcoholic, but I always shall be.  Not everyone will be an alcoholic, but anyone can be. These statements I believe to be true.

It's been over five years now, since I had my last drink.  Time to remember, reflect, and share.

Some people I know were out of control with their drinking from day one.  Not me.  It was probably harder for me to admit I was an alcoholic because I had thirty years or so of normal drinking patterns that seemed like evidence to the contrary.  For most of my adult life I drank an occasional beer, mostly during the summer months, during football season, and with certain meals such as pizza.  There were some occasions where I drank heavily, such as at the pastor's conference.  But most the time I drank no more than a beer or two.  And only occasionally.

Then life happened.

First I was prescribed Ativan for depression, insomnia, and anxiety.  It is a drug that works on the same receptors in the brain as alcohol, with effects so similar that it is also used to manage alcohol withdrawal symptoms in treatment.  I was told point blank at the time that I had to quit drinking.  My psychiatrist put it this way:  "I can't effectively treat your depression if you continue taking a depressant (alcohol).  No problem.  I just didn't drink.

What the doctor didn't tell me is that long-term usage of Ativan can produce "tolerance, dependence, addiction, benzodiazepine withdrawal syndrome, cognitive impairments, etc., which is why it is generally not recommended for use treatment beyond two to four weeks."  However, it is often prescribed for long term use.

After a number of years, a change of employment, a new home, I felt great and decided to cease treatment for depression.  My doctor, Brad, recommended I reduce the dose of Ativan prior to ceasing completely, and also warned that some people develop a drinking problem after going off of Ativan.  I was unphased because I had never had a drinking problem, and was quite confident I never would have.

Prior to ceasing medication I had begun to drink moderately, as in 6 to 7 fluid ounces of Scotch per week.  A couple of Scotch doubles, usually on the night a friend came over for dessert.  In spite of my doctor's warning, that drinking became a nightly affair immediately upon quitting Ativan.  My financial records of purchases confirm that I was now drinking 6 to 7 fluid ounces a day, not a week.

This is what I believe happens in the development of alcoholism.

First of all, a normal person has an adverse reaction to alcohol as a toxin in their body.  That's why it's called 'intoxication'.  Some people such as my wife so dislike this feeling that they will not drink enough to even begin to feel the effect.  Many people like the feeling of early intoxication.  That' why they drink.

When a consistent pattern of drinking develops, the body adapts to the presence of alcohol in the system, called 'habituation', and no longer has as strong a reaction against the alcohol as before.  The drinker who once got a buzz with the first drink now must drink more to feel the same effect.  Which if you are drinking for the effect means you will drink more.

The next stage is that as one drinks more and more to achieve the effect of intoxication the body adapts to the presence of alcohol to the extent that it now has an adverse reaction to the lack of alcohol in the system, that is withdrawal symptoms, not to the presence of alcohol in the system.  During a particularly stressful time in my life I stated to a friend that "It takes two drinks for me to feel sober."  I thought it was a joke but it was actually true.  I had to drink to feel normal.  At that point I had become an alcoholic, beyond a doubt.

Though an alcoholic probably doesn't realize this.  Toward the end, I was concerned that my congregation might smell alcohol on my breath Sunday morning, so I quit drinking Saturday night.  I got the shakes Sunday mornings as a result, though I didn't understand it to have anything to do with my drinking.  I couldn't pour the wine from the pouring chalice.  I didn't know what was happening but blamed it on stress, or something.  Only after treatment did I recognize I was going through detoxification.

If an alcoholic could simply manage by maintaining a base level of alcohol in their system at all times they would.  Anything to avoid withdrawal.  But the problem is with the habituating properties of alcohol.  It takes more and more to achieve the same effect.  But there is only so much of this toxin that the body can tolerate-- before it simply shuts down.  That shut down comes first as 'passing out'.  And then, the body's systems get so depressed they shut down entirely--that's called dying, by the way.

My rock bottom came in part because a doctor had prescribed Ativan again for me.  Circumstances at work sent my into a rage one afternoon, and after consuming a fifth of Scotch that afternoon and evening, I still felt I needed something and so I took Ativan.  The combination of the two almost killed me.

Why does an alcoholic allow this to happen?  One of the reasons is that to the alcoholic it appears that they are in control.  I used alcohol to 'control' my moods, or so I thought.  This is one of the reasons people with mood disorders such as Bipolar Disorder often become addicted.  Alcohol gives them some control.  One drink, two drinks, three drinks, four, I knew what I was drinking for.  "I'm in control" means "I don't need help".  Do you have a drinking problem?  No, I have no problem drinking.

I avoided some of the pitfalls of drinking.  I sat out on my deck, drinking myself to sleep at night, but rarely drank out on the town, and did not drive drunk (well, not very often).  My heaviest consumption was when I was alone.  Most of the time I convinced myself that I was only having a couple of drinks, a nightcap, and that was not a problem.  At the end those couple of drinks averaged 9 to 10 fluid ounces a day of Scotch.  Bigger glasses, less ice, kept the 'drink' total at two.  The truth is that 9 to 10 fluid ounces is consider at the minimum, 7 drinks, some would consider it 10.  That sounds like heavy drinking.  And it was an average.

Now I'm free.  I've gone through detoxification, dealt with many of the issues that contributed to the drinking, and no longer experience cravings.  The smell of Scotch is repulsive to me, now.  I can be around people drinking wine or beer, just not Scotch.

I share my story hoping that it will not be your story.  Even a lifetime of drinking normally is no guarantee against developing alcoholism.  Some people are more prone than others, but it is possible, I am convinced, for anyone to become alcoholic.  No one is immune.  Especially vulnerable are those with other issues like bipolar disorder, depression, or other mental illnesses.  Genetics can also play a role.

I don't have a problem with  normal people drinking normally.  Some people drink for the taste, not the effect.  Some people drink occasionally, not consistently.  Some people will enjoy their last drink like they enjoyed their first.  But not all.  Remember that.

Who's crazy?

Time and time again when our country faces the aftermath of another mass murder you hear choruses of people blaming mental illness for the shooting.  "We don't have a gun control issue, we have a mental illness issue."  OK, well either way, we have an issue.

I've heard it said by military folk that "if you believe military weapons are available to the general public, you don't have a clue what the military has for weapons."  That said, some very impressive stuff is available to the general public.  Consider for example this Barrett Barr M107A1 .50 BMG Centerfire Rifle.

I picked this out because its the most expensive semi automatic rifle Cabelas sells.  A fifty caliber bullet.  Easily a quarter mile range, probably a whole lot more.  A price tag of $12,000.  I have the feeling that one would want to make sure one's tree stand is solid before letting off a few rounds.  There are probably some people crazy enough to take this on a deer hunt.  But it's not really a hunting rifle.  Let's be honest about that.

Now, personally, I think anyone who buys such a rifle for hunting IS crazy.  But such weapons are not of the type responsible, and normal, hunters buy.

But if you want to sit back and take pot shots at a crowd of people from a thousand yards this is your gun.  The question is who would want to do that.

Well, apparently a certain number of people would.  If we define a person who is angry enough to kill as mentally ill, then I suppose we can say that we have a mental  illness problem.  But to blame that portion of the population that has a mental illness diagnosis for the mass murders that are taking place is misguided.  The vast majority of those with mental illness are not a threat to anyone except, in some instances, themselves.  

We have a mental illness problem.  Yes, we do.  People don't understand mental illness.  One issue is that people don't recognize the difference between a rage, and mental  illness.  When people fail to deal with their anger issues in a healthy manner they can spiral out of control into a rage, a violent, uncontrollable anger. Yet that is different than being bipolar, or depressed, or schizophrenic.  

The real issue we have regarding mental illness is the availability of mental health care and affordability of the same.  It can take months to set up an appointment with a psychiatrist, and a single visit can cost upwards of $500.  That's a challenge, especially if one does not have insurance that covers mental illness.

Should the mentally ill be allowed to purchase guns?  I can speak for myself.  I got rid of my guns under the counsel of my doctors.  "It has been clinically proven that one is more likely to die of a self inflicted gunshot wound if one actually has a gun."  It's just not a good combination to be depressed and own guns.  But I was never a threat to anyone else.

What I think is insane is allowing weapons such as the .50 caliber piece above to be so readily available.  Who needs such weapons?

Hunters do not.  Even those who want to have firearms for self defense do not.  I cannot imagine anyone being able to identify a 'threat' at a thousand yards and legitimately kill them in self defense.  And one hardly needs a fifty caliber rifle to defend one's self against an intruder in your home.  

If you're a drug lord in Juarez you may have need for one.  I wonder how much they spend at Cabelas?

There is a reason these are called assault rifles.  And not 'defense' rifles.  Or 'hunting' rifles.  Or even 'target' rifles.  It's because the only legitimate purpose for them is killing at a long range.  With overwhelming force.

Are the mentally ill buying such guns?  Well, there is an easy solution if that's the problem.  Require someone to submit to an mental health evaluation before allowing them to purchase such a weapon.  It won't work though, because we don't have enough psychiatrists and because the people buying these weapons are not mentally ill.  My guess is that aside from drug cartels, most of the people  buying assault weapons are merely gun enthusiasts.  They think its cool being able to blow up a watermelon at a thousand  yards.  

These same people, could they afford it, and were they available, might like to collect Abrams M1A2 tanks.

But back to the issue.  Who is really insane?  A bipolar person who is struggling to maintain a balance in their moods?  Or an entire culture that insists on making available weapons that have only one legitimate purpose, and that is killing at an incredible distance? 

Crazy world we live in.  You can buy some pretty incredible weapons online.  It's like making LSD available as an over the counter drug.  And people think I'm the crazy one.