Friday, November 27, 2015

Is remission from depression possible?

The psychiatrist that I've been seeing for over two years keeps a picture in his office that looks like this:

I glance at it every time I go to see him and wonder if my brain truly resembles something like the picture on the left. It looks like the lights are turned out, as if the brain is stuck on a dimmer switch after years of enduring depressive symptoms. I can actually pin-point each little highlighted area as an avenue in my life that is relatively high-functioning despite my depression: my relationships, my work life, my creative life, and the time I spend thinking about my goals and dreams.

Not all depressed people can say that. 

I often consider what my life would be like if my brain was fully alive and on fire like the picture on the right; brightly lit up and glowing with possibilities and promises. Changes. Challenges. Growth. The stuff of personhood. The way I would live my life everyday if I could.

Then I think about how I often feel in the day-to-day: The numbness. The void of emotions. The afternoons wasted in bed. The cancelled brunches with friends. The missed meetings and appointments. The excuses that follow. The weight-gain. The constant negative monologue that has taken residence in my brain. The frustration. The "I'm not good enough's" and the "I never will be's." The debilitating guilt and shame. And the medications - so many medications!

I recently told my doctor that it feels like I experience a low-lying level of undulating depression most of the time. My medications have to be adjusted every 3 - 4 months just to keep me functioning at the level I need to fulfill my current responsibilities. If not, I'll crash and have been known to become suicidal. This can't be an optimum way to live. 

One day at my doctor's office, after complaining again that my medications just weren't cutting it, he told me about a procedure called Trans-cranial Magnetic Stimulation, or TMS. It's a relatively new procedure that has developed over the last 5 - 10 years. 

My understanding of TMS is that it is a non-invasive treatment for types of depression that do not respond well to antidepressants. It can also be used with patients who experience unbearable side effects from drug therapy. It utilizes similar technology as an MRI, hence the non-invasive classification. The patient sits in a dentist's office-type chair where a large plastic headband is placed over the head. The metal coil, which distributes magnetic pulses, is placed directly over the patient's prefrontal cortex, or the part of the brain that is thought to control one's mood along with many other things. The magnetic pulses are supposed to stimulate and eventually retrain the neurotransmitters in the brain that have forgotten how to make essential brain chemicals such as dopamine, serotonin, and norepinephrine.  The treatment is administered for about 45 minutes. As the magnetic pulses are delivered, the patient feels a repetitive tapping sensation on the head. The patient can go back to work immediately after receiving treatment. 

TMS is not ECT, or Electroconvulsive (shock) Therapy. There is no need for general anesthetic, and there is no risk of memory loss. In fact, the side effects for TMS are minimal: pain at the sight of the metal coil, headaches, and muscle twitches. Most of these are known to disappear after a week or so of treatment. Treatments have been known to last for as many as five days a week for six weeks in a row.

My doc said that about 1/3 of TMS patients experience complete remission from depression. Many are able to go off of their antidepressants entirely. Some are able to cut down to one maintenance-sized dose of medication. 

Good Lord, sign me up.

Pending my insurance's approval, there is a good chance I could begin TMS treatment in early 2016, as my doctor said I was a good candidate. Not only does medication not perform as it should for me, I've experienced several undesirable side effects along the way. It's been six long years of drug therapy. Now I'm ready for another chance. Something new, something with potential. 

TMS could be a solution for me. On the other hand, it may not. In the meantime, I will remain hopeful for the future and thankful that I have insurance that will most likely help me cover the cost of treatment.

Until then, be well, be kind, and hope on.

To our health,


Friday, July 31, 2015

All My Hope on God is Founded: Mental Health and Hymns that Heal

Over two years have passed since my last blog post. As one might expect, I am still pressing forward  on the journey toward mental health and wellness. On the up-side, the last two years have brought me better insight into my illness. Each time I experience an episode, I learn more about my depression and how it changes each time it surfaces. I learn that it is always best to error on the sides of more communication, more preventative therapy, and more self-care initiatives. I learn that no matter how accomplished I become at being able to take responsibility for my own mental health, my depression is still difficult on my spouse.

The last two years have also been a struggle. Until very recently, I have been in a constant state of low-lying depression. I've also tried to figure out, with no success so far, how to shed the weight I have gained since being on antidepressants. It's a love-hate relationship, me and my medications. I know they serve me well. I feel better when I take them regularly. This I know to be true. But I never thought I'd witness the transformation my physical body has undergone since beginning the meds just over four years ago. Despite all of this, at least for now, I know that taking the meds is a necessary part of my mental health regimen. This was confirmed by a stay in a psychiatric facility this past December when I became suicidal. I missed an appointment with my psychiatrist a couple weeks before and failed to get my meds adjusted. The affect it took on my brain was one I didn't see coming. Suddenly, in a huge wave of tearful despair, as I held several pill bottles in my hands, I considered an act that could have ended my life.

So I admitted myself.

Five days and four nights later, I realized I never want to go there or feel that way again.

I have a couple of reasons for wanting to resurrect this blog, one being the reason I started it in the first place: because I believe that in reaching out and talking about mental health, together we help reduce the stigma that still surrounds mental illness. My other reason is to share a recent presentation I gave at the Hymn Society Conference a week or so ago. Some of you have asked to see a copy of it, so I will paste a slightly edited version of it below.

For those of you who may be unfamiliar with this organization, The Hymn Society was founded in 1922 as a way to affirm that congregational song is an integral part of worship. The Hymn Society advocates that the singing and writing of new hymn texts should be promoted while honoring our hymnic past by studying the origin of preexisting texts, tunes, and performance practice. My presentation was entitled All My Hope on God is Founded: Mental Health and Hymns that Heal and focused on the role that music ministry leaders can play in the healing journey of others through the communal singing of hymns.

Please enjoy:

“All My Hope on God is Founded: Mental Health and Hymns that Heal”
The Hymn Society in the United States and Canada
Tuesday, July 14, 2015, 4:00 – 5:15 pm

Begin by singing verses 1, 2, & 3 of ALL MY HOPE ON GOD IS FOUNDED 
Evangelical Lutheran Worship, #757

All my hope on God is founded
who will all my trust renew,
who through change and chance will guide me,
only good and only true.
God unknown,
God alone,
call my heart to be thine own.

Mortal pride and earthly glory,
sword and crown betray our trust;
what with care and toil we fashion,
tow'r and temple, fall to dust.
But thy pow'r,
hour by hour,
is my temple and my tow'r.

Great thy goodness, e'er enduring;
deep thy wisdom, passing thought;
splendor, light, and life attend thee,
beauty springing out of naught.
from thy store
new-born worlds rise and adore.

Text by Joachim Neander, 1650-1690; para. by Robert Bridges, 1844-1930

Welcome to the sectional entitled “All My Hope on God is Founded: Mental Health and Hymns that Heal.” I am delighted to see so many of you here this afternoon. That tells me the issues we’re going to talk about and the music we’re going to sing are of great importance to what it means to be a welcoming church to all people. I am a former Austin Lovelace Scholar, and am thrilled to be back at this year’s conference as a presenter. For our discussion purposes today, I hope to begin by clarifying: just what is mental illness? What are some of its different names and forms? Who is affected by it? And what can be done? After which we’ll focus on the Church and its relationship to those with mental health disorders. In the midst of all of this, we’ll be doing some hymn-singing and carrying on some discussion. And most importantly, we’ll discuss how we as church musicians play not just musical, but pastoral roles in the healing journey of others. Let’s now sing a hymn that talks about a spirit of Christian service to the poor in spirit and the mournful – a beautiful text by Delores Dufner. 

Evangelical Lutheran Worship, #551

The spirit sends us forth to serve;
we go in Jesus’ name 
to bring glad tidings to the poor,
God’s favor to proclaim.

We go to comfort those who mourn
and set the burdened free;
where hope is dim, to share a dream
and help the blind to see.

We go to be the hands of Christ,
to scatter joy like seed
and, all our days, to cherish life,
to do the loving deed.

Then let us go to serve in peace,
the Gospel to proclaim.
God’s Spirit has empowered us;
we go in Jesus’ Name.

Text: Delores Dufner, OSB, b. 1939

 What Is Mental Illness?

First, let’s talk about what it means to suffer with a mental illness. The World HealthOrganization defines mental health as: 
“a state of well-being in which every individual recognizes his or her own potential, can cope with the normal stresses of life, can work fruitfully, and make a contribution to his or her community.”

 Winston Churchill had his own name for his manic depression – his little black dog -which often appeared for a month or so at a time as manic depression. DBSA, or the Depression and Bipolar SupportAlliance, tell us that depression is an imbalance of brain chemicals called neurotransmitters and neuropeptides. No one is certain what exactly causes depression, but many believe it is a combination of genetic, biologic, environmental, and psychological factors. I’m sure you’ve all experienced bouts of situational depression in your lives at some point in time. Maybe you lost a job, went through a divorce, or had to say goodbye to someone you really cared about. The feelings of sadness and pain that arise from occurrences like these are valid and real. People who suffer from clinical depression often have long lingering, persistent symptoms that last for years, even decades. When I first acknowledged my struggles with mental illness out loud, I remarked that, 
“things that seem so easy for other people just aren’t easy for me.”
That was the best way I knew how at the time to describe the battle I had to fight everyday just to survive. Getting out of bed in the morning to go to class was a momentous effort. Taking a shower seemed exhausting. I turned to drugs and alcohol to numb the disgust I harbored for myself and for the life that I was stuck inside. And a social life? Forget about it. Sometimes I holed myself up in my apartment for several days at a time seeing no one and speaking to nobody. I knew in my heart this was no way to live. 
Later, when I was 27, I found out that all of these behaviors were symptoms of common illnesses called Major Depressive Disorder and Generalized Anxiety Disorder. Anxiety is also a common affliction for many people, but those people who suffer of GAD are prone to obsess over their concerns. They can’t relax, startle easily, have difficulty concentrating, and have trouble falling or staying asleep. Anxiety is often accompanied by fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, feeling out of breath, and hot flashes. These symptoms may seem manageable when listed one by one, but for those suffering with a mental health disorder, they are chronic and debilitating. 
Everyone experiences depression and anxiety differently, but the National Institute ofMental Health (NIH) clearly describes Major Depressive Disorder as severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life for a period of two weeks or more. Other types of depression include Persistent Depressive Disorder, otherwise known as Dysthymia, where symptoms of depression are consistent for a period of two years or more. There is also Psychotic Depression, where people experience severe depression plus some form of psychosis, delusions and/or hallucinations. Another form of depression that has been around for many years and is just now beginning to be talked about in the mainstream media is Post-Partum Depression, or when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth. Maybe you or someone you know often has the ‘winter blues.’ Seasonal Affective Disorder is characterized by the onset of depression during the winter months, when there is less natural sunlight. Finally, Bipolar Depression, is characterized by cycling mood changes—from extreme highs known as mania to extreme lows of depression. 
There are also psychotic mental health disorders, which we’ll just touch on briefly. The most common psychotic mental health disorder is Schizophrenia, a chronic, severe, and disabling brain disorder that occurs in 1 percent of the general population – that’s 3.2 million people - but it occurs in 10 percent of people who have a first-degree relative with the disorder, such as a parent, brother, or sister. People with the disorder may hear voices and may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. Treatment helps relieve many symptoms of schizophrenia, but most people who have the disorder cope with symptoms throughout their lives. However, with proper treatment and guidance, many people with schizophrenia can lead rewarding and meaningful lives in their communities. Let’s move on to another hymn, “When Hands Reach Out and Fingers Trace,” a text by Carolyn Winfrey Gillette. As the footnotes read, this hymn celebrates the richness of our human diversity through all of the different ways we serve the church and the world. Acknowledging this diversity witnesses to the hospitality of Christian community and to the inclusive nature of God’s love. 

Glory to God #302

When hands reach out and fingers trace
The beauty of a loved one’s face,
We thank you, God, that love relies
On gifts of grace not seen with eyes.

When fingers spell and signs express
Our prayer and praise and thankfulness,
We thank you, God, that hands can sing;
You bless the silent songs we bring.

When broken bodies will not mend,
We thank you, God, for Christ our Friend.
In him, our healing can begin:
He welcomes all the wounded in.

And when the ways we learn and grow
Are not the ways that others know,
We thank you, God, that we have learned
Your love’s a gift, and never earned.

Your Spirit gives us differing ways
To serve you well and offer praise.
When all are joined as one, we’ll be
Your able, strong community.

Text by Carolyn Winfrey Gillette, 2001

What Does Mental Illness Look Like
Ultimately, mental illness looks like you and me. Mental illness is mainstream and does not discriminate. It can affect anyone regardless of age, gender, income level, social status, race, religion, or any other cultural identity factor. One in four people struggle with a diagnosable mental illness in any given year. This equates to 80 million people in the United States alone, which is equal to the total number of people diagnosed with cancers, heart disease, HIV/AIDS, and diabetes each year. Mental health disorders are the number-one cause of disability in North America. Today, in many churches, there is an emphasis on successful Christian living that seems to say that real Christians don’t have problems. Or at least, there are no problems that prayer can’t remedy. How many of us have heard that? However, in her 2013 book entitled, “Troubled Minds: Mental Illness and the Church’s Mission,” author Amy Simpson points out that this idea is in direct contradiction to what Jesus told us in John chapter 16:
“Here on earth you will have many trials and sorrows, but take heart, because I have overcome the world.”

So what do all of these facts and figures mean for us as faith leaders? They mean there are people right now in our pews, on our church staffs, and in our ensembles who are battling mental illness. The good news is that mental illness is treatable, and we as faith leaders can be a part of this healing process. If we are called to be pastors to our flocks, it’s certainly appropriate that we be aware of how we can better serve those who are struggling. It is part of our job, yes – even as church musicians – to be prepared to help care for those individuals who so often come to the Church first when seeking help for their most intimate and personal of life’s problems. The fellowship, good will, and emotional support that a church can offer can promote healthier living and encourage better mental stability. But changing a part of any community’s culture can be a challenge. Everyone must start somewhere, and author and mental health advocate Amy Simpson started with the numbers.
What Mental Illness Looks Like in the Church
Simpson writes about a survey she conducted in conjunction with the Leadership Journal and other Christianity Today publications. She interviewed pastors and other worship leaders in 500 different churches and asked them about their experiences with mental illness among members of their congregations, in their families, and personally. Simpson also took time to ask what their churches believe about mental illness, how they treat people with mental health disorders, and how frequently they mention mental illness in their sermons. The data is fascinating and very telling. Let’s take a look:

·      84% of church leaders are aware of some type of anxiety disorder in their congregation

·      91% of these church leaders have seen mood disorders such as depression within their churches

·      37% of church leaders indicated that someone in their congregation had suffered from a psychotic disorder such as schizophrenia

·      38.% of these church leaders admitted they themselves had suffered from a mood disorder such as depression or bipolar disorder. 

·      Of those surveyed, 29% said that on average, mental illness is NEVER mentioned in sermons at their church; 20% said mental illness is mentioned once a year, and 29% two to three times a year.

As you can see, we’ve got some work to do, but progress is possible. No matter our affliction, we all come together week after week to confess our sins, listen to the proclamation of the Word, sing the psalms, hymns, and spiritual songs that reaffirm our Christian stories, and partake in the Eucharistic meal. We are then told to “go out to love and serve the world!” But what about those who cannot “go out to love and serve” because their own pain is so debilitating they cannot even get out of bed in the morning? We cannot change everything about the suffering involved with mental health disorders. We can’t take mental illness away, but as the church, we can do better by striving to be a place of refuge and acceptance for all the afflicted. The hymn we’re going to sing now by Ruth Duck is like a sung prayer for people whose lives exist in constant pain, often without hope. I think it’s appropriate to mention here that all of the hymns we’re singing today are just as much for the mentally ill as they are for their tireless caretakers, who also need recognition, love, and reassurance of hope for the future where they and their loved one can one day exist without pain. 

Glory to God #807

When we must bear persistent pain
and suffer with no cure in sight,
come, Holy Presence, breathe your peace
with gifts of warmth and healing light.

Support us as we learn new ways
to care for bodies newly frail.
Help us endure, and live and love.
Hear our complaint when patience fails.

We thank you for the better days
when we may smile to greet the sun,
to do your work with clearing mind,
and bless your name when day is done.

In ease or pain, in life and death,
to you our fragile lives belong,
and so we trust you in all things.
You are our hope, our health, our song.

Text by Ruth Duck, 2004

“Just Be a Pastor”
As I mentioned to you earlier, when I was 27, I was diagnosed with a mental illness. I continued to work and attend graduate school during this time. As a church musician interested in building community and spreading awareness for mental health advocacy, I knew that voicing my struggles would somehow help other people. I figured that since we all happen upon difficult times, we should not only be talking about them; we should also be SINGING about them as a means to heal. I suspected that by singing about our pain collectively, hymns could become a vehicle for people to address their struggles in the Church in the presence of a loving God who walks by our side as we navigate our way through this fallen, broken world. 
I once received some very astute advice from a fellow church musician friend of mine that has stuck with me through the years because it speaks to what I believe is part of my ministry as a church musician. I had just accepted my first full-time church position in a Lutheran Church – a denomination I had never served in before.  Excited and nervous, I asked my friend if he had any advice for me as I began my new position. He said to me, “Hillary, just be a pastor.” 
      Just be a pastor. Of course. 
The Apostle Paul writes to us in the third chapter of Colossians that the mission of the church is to treat each other with 
“tenderhearted mercy, kindness, humility, gentleness, and patience.”
 If any of you have ever dealt with mental illness in your families or circles of friends, you know that all of these things are necessary for both parties as they deal with the illness. Paul writes further: 
“Teach and counsel each other with all the wisdom God gives. Sing psalms and hymns and spiritual songs to God with thankful hearts.”

Most of us in this room have the psalms, hymns, and spiritual songs part covered, but to counsel each other with patience and wisdom requires us to take on other roles in addition to being musicians. 
I had known for several years that being a church musician entailed much more than what we’re taught in our church music classes. There is so much we are not exposed to within the safe confines of the conservatory walls: working with fellow church staff and clergy, navigating church polity, collaborating with others while serving on various committees, and of course, tending to the often non-musical needs of parishioners. We should all expect to bump up against mental illness in our ministries. After all, the Church is where all of the broken gather; where the lost and the marginalized come looking for rest. Let’s sing again, this time, a text by Bryan Jeffrey Leech that speaks to our mission to be the hands of Jesus to those in need. I love this hymn because it reminds us that it is a privilege to care for a world in want. One by one, we can let our hearts soften as we tend to God’s creatures in their time of need.
Community of Christ, #353

Let your heart be broken for a world in need:
feed the mouths that hunger, soothe the wounds that bleed,
give the cup of water and the loaf of bread – 
be the hands of Jesus, serving in his stead.

Blest to be a blessing, privileged to care,
challenged by the need – apparent everywhere,
where the world is wanting, fill the vacant place.
Be the means through which the Lord reveals his grace.

Add to your believing deeds that prove it true.
Knowing Christ as Savior, make him Master, too.
Follow in his footsteps, go where he has trod;
in the world’s great trouble risk yourself for God.

Let your heart be tender and your vision clear;
see the world as God sees, serve him far and near.
Let your heart be broken by another’s pain;
share your rich resources, give and give again. 

Text by Bryan Jeffrey Leech, b. 1931

Linking Hymns and Mental Health
It’s nothing new that music has many healing properties. So much, in fact, that the relatively new field of music therapy emerged and is a part of healing regimens for many ailments, including mental illness. I want to delve in a bit further and draw your attention to a study that was completed by a team from the University of the Highlands and Islands in Inverness, Scotland, and a group from the Christian Council on Ageing, an advocacy group from the United Kingdom. The study, entitled “Hymns and mental health: A survey of church attendees” was partly inspired by the man sometimes known as the “Father of pastoral care,” Anton Boisen (1876 – 1965), who was from my home state of Indiana. Boisen suffered from mental illness to the point of several hospitalizations. In 1937, he published a hymn collection called “Hymns of Hope and Courage,” which was intended for:
“those who are passing through the valley of conflict and shadow. It provides a compact collection of hymns and prayers and passages of scripture designed to deepen the aspiration for a better life, to strengthen faith in the love and healing power of God, and to foster attitudes of hope and courage.”
Anton Boison (1876-1965)
The collection includes some very familiar hymns, such as “Abide with Me,” “Dear Lord and Father of Mankind,” and “Guide Me O Thou Great Jehovah,” along with several Christmas carols. Boisen was particularly influential in this study because he believed that hymns were a medium for deep emotional response, especially in situations of group therapy.

Hymns of Hope and Courage, #32

‘Twixt gleams of joy and clouds of doubt
Our feelings come and go;
Our best estate is tossed about
In ceaseless ebb and flow.
No mood of feeling, form of thought 
Is constant for a day;
But thou, O Lord, thou changest not;
The same thou art always.

Our of that weak, unquiet drift
That comes but to depart,
to that pure heaven my spirit lift
Where thou unchanging art.
Lay hold of me with thy strong grasp,
Let thine almighty arm
In its embrace my weakness clasp,
And I shall feel no harm.

Thy purpose of eternal good
Let me but surely know;
On this I’ll lean – let changing mood
And feeling come or go – 
Glad when thy sunshine fills my soul,
Nor lorn when clouds o’ercast,
Since thou within thy sure control
Of love dost hold me fast.

This study was conducted on 394 men and women in order to examine the subjective effect that hymns can have on one’s overall well-being. The team analyzed whether or not singing or listening to hymns could help mental health by uplifting the subjects’ spirits to overcome depression.  The study measured participants’ responses to four main objectives:

·      What religious group (or denomination) they affiliated with

·      Whether or not they found certain hymns to be able to raise their spirits and make them feel better

·      Whether it was the text, tune, or both text and tune that gave them the most positive affect

·      Whether they preferred to sing or just listen to the hymn

It was discovered that most of the participants considered themselves moderately to highly religious and/or spiritual people. The team’s hypothesis that hymns are able to lift one’s spirit when feeling down or depressed was supported by a mean score of 3.52 out of 4; a very high indication that their hypothesis was correct. The study also concluded that 244 participants, or 64% of those questioned indicated they preferred to experience the words with the tune, meaning the relationship between text and tune is important to how they experienced a hymn. And now, for my favorite part: 63.4% of the people questioned said they felt they needed to sing the hymn – or actively participate – in order to feel like they had received all of the benefits of the hymn. Martin Luther would certainly be pleased with this result. We can conclude that at least for those who profess a faith, hymns play an important role in their lives. The subjects were also asked to name their top three hymns. Just for fun, let’s take a look at the list of highest ranked favorites:

1.)  Dear Lord and Father of Mankind [REPTON]
2.)  Love Divine [BLAENWERN]
3.)  O Lord my God [HOW GREAT]
4.)  Great is Thy Faithfulness [GREAT IS THY FAITHFULNESS]
5.)  The Lord’s My Shepherd [CRIMMOND]
6.)  Make Me a Channel of Your Peace [PRAYER OF ST. FRANCIS]
7.)  What a friend we have in Jesus [CONVERSE]
8.)  Praise My Soul the King of Heaven [PRAISE MY SOUL]
9.)  And Can It Be [SAGINA]
10.)                 Guide Me, O Thou Great Jehovah [CWM RHONDA]

The Hymnal 1982, #653

 Dear Lord and Father of mankind,
forgive our foolish ways;
reclothe us in our rightful mind,
in purer lives thy service find,
in deeper reverence, praise.

 In simple trust like theirs who heard
beside the Syrian sea
the gracious calling of the Lord,
let us, like them, without a word
rise up and follow thee.

 O Sabbath rest by Galilee,
O calm of hills above,
where Jesus knelt to share with thee
the silence of eternity,
interpreted by love!

 Drop thy still dews of quietness,
till all our strivings cease;
take from our souls the strain and stress,
and let our ordered lives confess
the beauty of thy peace.

 Breathe through the heats of our desire
thy coolness and thy balm;
let sense be dumb, let flesh retire;
speak through the earthquake, wind, and fire,
O still, small voice of calm!

Text by John Greenleaf Whittier (1807 – 1892)

Hymns & Music for Further Study
Depression is a disease of loneliness. Depressed people feel alone, isolated, even forgotten. They may feel that God has overlooked them and their cries for help. The Church has a responsibility and an opportunity to create a community around our sorrows just as it forms a community around our joys. When planning a service of healing or a hymn festival to bring awareness to the presence of mental illness in the church, I often turn to an anthem by Mark Miller called “I Believe.”  The text is a very simple poem:
I believe in the sun
even when it is not shining
I believe in love,
even when I cannot feel it.
I believe in God,
even when God is silent.

This poem, thought to be written by a Nazi war prisoner at a concentration camp, is powerful, even haunting. It reminds us of the choice some of us have to hope for those things we cannot see or feel. Sometimes, however, some folks are not well enough to make certain choices. How can we enable these people who are struggling to voice their inmost longings to be heard and healed? There is a hymn in Evangelical Lutheran Worship (ELW) that gives this darkness a voice by acknowledging that sometimes in the midst of our pain, we simply have nothing to give. Let’s all sing:
Evangelical Lutheran Worship, #699

In deepest night, 
in darkest days,
when harps are hung,
no songs we raise,
when silence must suffice as praise,
yet sounding in us quietly
there is the song of God.

When friend was lost,
when love deceived,
dear Jesus wept,
God was bereaved;
so with us in our grief God grieves,
and round about us mournfully
there are the tears of God.

When through the waters 
winds our path,
around us pain,
around us death:
deep calls to deep a saving breath, 
and found beside us faithfully
there is the love of God.

Text by Susan Palo Cherwien, b. 1953
Susan Palo Cherwien wrote this text in 1994 as a “Christian response to grief.”  Paul Westermeyer notes in his hymnal companion to the ELW that in all three stanzas, Cherwien manages to point back to “God’s presence in our pain, numbness, silence, awareness, lack of awareness, and questions.” In my church, we often sing this hymn as part of our Blue Christmas service. Sometimes we sing it together. Other times, the congregation sits and listens to it as it is sung by a solo voice. Regardless of how it and other hymns like it are sung, the very act of coming together to sing about our pain as a church community creates healthy connections with other people – especially people who will point each other toward Christ. Blue Christmas services provide a healthy outlet to those for whom the holidays are a particularly tough time. If your congregation has never experienced a Blue Christmas Service, I urge you to comb through Susan Gregg-Schroeder’s website, where you can obtain sample services along with several other valuable resources for churches wanting to incorporate issues of mental health into their worship life. It’s often helpful at these types of services to plan several shorter, Taize-type songs that people can latch onto easily. Songs such as:

Calm to the waves [CALM SEAS] Glory to God #184
Stay with Me [STAY WITH ME] Evangelical Lutheran Worship #348
Jesus, Remember Me [REMEMBER ME] Evangelical Lutheran Worship #616
Nada te turbe, Community of Christ #241

Other appropriate choices include, but are not limited to:
This is a Day of New Beginnings [BEGINNINGS] New Century Hymnal #417
How Long, O Lord [HOW LONG, O LORD] Glory to God #777
We Cannot Measure How You Heal [YE BANKS AND BRAES] Glory to God #797
Heal Me, Hands of Jesus, Wonder, Love, and Praise # 757

Wonder, Love, and Praise #773

Heal me, hands of Jesus,
and search out all my pain:
restore my hope, remove my fear 
and bring me peace again.

Cleanse me, blood of Jesus,
take bitterness away;
let me forgive as one forgiven
and bring me peace today.

Know me, mind of Jesus,
and show me all my sin;
dispel the memories of guilt,
and bring me peace within.

Fill me, joy of Jesus:
anxiety shall cease
and heaven’s serenity be mine,
for Jesus brings me peace.

Text by Michael Perry, 1982

I will admit to you that during the darkest days of my depression, I often wondered where God was when my pain was the deepest. For a long time, I continued to serve the church and follow through with my musical programming, but I often felt that I was going at it alone. Like others who try to reconcile their spirituality with their mental illness, I often felt that I was crying out to a silent God. Amy Simpson writes, 
“what hurting people need…is to know that they are not alone, that someone else will hear their story and will love them just as much after they tell it. They need to know that the pain does not mean God has turned his back on them.”

Simpson adds, if we as the church are silent to a person in pain, it “can sound remarkably like silence from God.” For me, it became necessary to decipher for myself just what is my illness, what is just me, and accept the fact that just because I cannot sense him does not mean God is not with me.

O God, my God, O gracious God,
why do you seem so far from me,
O God, my God, O gracious God?

Night and morning I make my prayer:
Peace for this place and help for there;
Waiting and wondering, 
waiting and wondering,
does God care?
Does God care?


Pain and suffering unbound and blind
Plague the progress of humankind,
Always demanding,
always demanding,
does God mind?
Does God mind?


Why, oh, why do the wicked thrive,
poor folk perish, the rich survive;
Begging the question,
begging the question,
is God alive?
Is God alive?


Turn again as you hear my plea;
Tend the torment in all I see:
Loving and healing,
loving and healing,
set me free.
Set me free.


I like that hymn from the New Century Hymnal by John Bell because it is a direct cry to God. As the hymnal says in the footnotes, “it exhibits the kind of stark honesty before God” that is characteristic of so many of the Psalms. Better yet, almost each verse ends with an open-ended question, which for me was like looking into a poetic mirror. Verse three strikes me particularly: “Is God alive? Is God alive?” 
As they always do, the really dark days did eventually pass, and as I began to put the pieces of myself back together, a new yearning was born within me. When I think about the team of people it took to get me through the worst of my illness, I realized that I wanted to be one of those people for somebody else. I wanted to use my experiences with clinical depression to help bring others closer to healing, and like many of you, the vehicle I’ve been given to complete this task is music and ministry.

Wonder, Love, and Praise #778

We all are one in mission,
we all are one in call,
our varied gifts united 
by Christ, the Lord of all.
A single, great commission 
compels us from above
to plan and work together
that all may know God’s love.

We all are called for service
to witness in God’s name.
Our ministries are different,
our purpose is the same:
to touch the lives of others
by God’s surprising grace,
so people of all nations
may feel God’s warm embrace.

We all behold one vision,
a stark reality;
the steward of salvation 
was nailed upon a tree.
Yet resurrected Justice
gives rise that we may share
free reconciliation
and hope amid despair.

Now let us be united
and let our song be heard.
Now let us be a vessel
for God’s redeeming Word.
We all are one in mission,
we all are one in call,
our varied gifts united
by Christ, the Lord of all.

Text by Rusty Edwards (1986), b. 1955

What Can We As Faith Leaders Do?
As you probably know, it takes time, endless efforts, and a strong will to change the culture of any organization, including the church. If you feel it is important that your church take up this cross and become an open and accepting safe haven for persons with mental illness, here’s a look into some good places to start.
Do Your Research
Like many of you, I am a collector of hymns and texts. When I began this journey toward bringing mental illness into the forefront of my church’s worship life, I began putting together a notebook of hymns and texts that deeply spoke to me about hope, healing, and the importance of community. I found and read books and articles authored by people whose writing on the subject I found to be insightful and encouraging. The works of Anton Boisen, Henri Nouwen, and Andrew Solomon are just a few examples. I took every chance I got to hear people sing or speak about what makes their heart whole..
            Engage Your Community’s Resources
When I served a mid-size United Methodist church in agrarian Southwest Indiana, there were very few resources available concerning mental health. So I turned to national organizations such as NAMI (National Alliance on Mental Illness) and DBSA (Depression and Bipolar Support Alliance). I sent away for free information about what it’s like living with a mental illness and what one can do to seek treatment. These were openly displayed around the church for people to read and share at their will. I shared my story with people in my ensembles and wrote devotions on the subject that were read at the end of each rehearsal during Mental Health Awareness Month. I organized a Mental Health Sunday in October where we sang hymns, listened to lessons, and heard a sermon that tied together the ideas of healing, wholeness, and God’s love for all struggling people. My current church is unique in that it actually has a counseling center attached to it, called the Samaritan Center. It was started in the mid-sixties by a minister who attends our church and still works at the center. That just goes to show you the power in one person! And what an opportunity to engage local mental health workers in a growing dialogue about mental illness and the church! Last year we combined forces and put together a community hymn festival that honored the 40th anniversary of the center. It also allowed people – some from the church and some not – to come together for a time of singing, readings, anointing, and community support.

            Enlist the Help of Your Pastors and Staff
Once you’ve gathered your music and research together and enlisted the support and involvement of your local mental health resources, it’s time to take your ideas to your pastors and staff. Together, you will hopefully be able to make a collective effort to begin to create a more inclusive, welcoming congregation around issues of mental health. It is here that you can dream your ideas into reality Maybe you want to:
·      Plan a community hymn festival around topics of mental health or healing

·      Begin a Blue Christmas service this coming winter

·      Invite local mental health advocacy groups to conduct workshops

·      Give closing devotions about mental health topics after your rehearsals and end in singing an appropriate hymn together.

·      Invite or initiate the formation of a support group for those dealing with mental illness. NAMI, DBSA, and Emotions Anonymous are a few such groups that often meet in churches

·      Make note of and even celebrate Mental Health Awareness Month in May. Include information in your rehearsals, in your announcement pages, on the church’s website, and in your worship services through music and the Word. 

·      Celebrate Mental Illness Awareness Week the first week of October. Have information available to your parishioners either in the Narthex or inserted into the worship folder. 

·      TELL YOUR STORY; reaching out to others, sharing your experiences, whether privately or publically, begins to carve out a safe space within the church for conversations about living with mental illness to begin. It begins with each of us. 

Use these and other ideas as opportunities to talk about and sing about mental health in your congregations. You will be surprised at how many people will be so thankful you did. Doing these kinds of activities can help reduce and even eliminate the stigma that so often surrounds mental illness. As faith leaders, we are all in unique positions to help educate people about mental health disorders in order to avoid the shame that often accompanies these issues. My belief is that if we can begin to talk about issues of mental health in our churches, we can certainly sing about them, too, in order to help people change their lives for the better. Again, the Church is on the front lines when it comes to dealing with those seeking help for mental illness. Those suffering often seek out a pastor or another staff member first. It is our responsibility as leaders of the Church to be equipped with the appropriate resources so we can point these folks towards further help. So go forth, educate, be aware, compassionate, collaborative, and just be a pastor. 
Still from earth to God eternal
sacrifice of praise be done,
high above all praises praising 
for the gift of God’s own Son.
Christ doth call one and all:
ye who follow shall not fall.