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  Living with Bi-Polar Disorder  
     
 
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William ("Dr. Bill") Gaultiere, Ph.D.
Director of New Hope & Psychologist with ChristianSoulCare.com
(714) 971-4213, DrBill@CrystalCathedral.org

INTRODUCTION

Johnny Carl was the much loved and brilliantly gifted Music Director of the Crystal Cathedral. He wanted nothing more than to honor Jesus and bless people with beautiful sacred music. He did this for 30 years while suffering terribly from Bi-Polar Disorder or Manic-Depression. Then on December 16, 2004 he killed himself during a mixed manic and depressive episode. He was not in his right mind. He had been recently hospitalized and put on a new stabilizing medication that he may have reacted to. One in five people with Bi-Polar Disorder die by suicide as Johnny did.

New Hope has received many dozens of calls and chats and e-mails from people since Johnny's suicide. Some are Bi-Polar or suffer from another mental illness themselves. Others are suicidal. Many, have loved one's who are mentally ill or suicidal that they're concerned about. Still others have difficult and troubling questions like, "Does mental illness cause a suicide or is it a choice? Is suicide a sin and if it is can you still go to heaven?" How do we respond to these types of calls?

Our New Hope Continuing Education class today is "Living with Bi-Polar Disorder." We're going to try to understand these issues and consider how we might offer help. After my presentation on Bi-Polar Disorder we're going to watch the 20 minute segment of Larry King Live which featured Dr. Schuller and Linda Carl discussing Johnnie's mental disorder and suicide. After that we'll discuss your questions and concerns.

Let's remember why we're here in this room. As New Hope Counselors we're offering ourselves to God to use our ears and our hearts to care for people who contact us with these issues. And that's not all. Amongst us are people like myself who have been personally touched by these painful issues. Either you or a family member or a friend suffer from Bi-Polar Disorder.

So let's begin with prayer. Let's all pray silently for the family and friends of Johnnie, for anyone you know who has Bi-Polar Disorder, and for the ministry of New Hope. Then I'll offer a prayer on behalf of us all.

BEAUTY FROM BI-POLAR DISORDER

Johnny Carl has left a lasting legacy of beautiful musical compositions. These will be played in churches around the world for many years to come. His suicide does not diminish the reality that in life he loved Jesus and led millions of people to worship and enjoy the Lord. It's tragic that in life, and especially in the hours leading up to his death, he had such tremendous difficulty experiencing the joy of the Lord that he brought to others.

Johnnie's story is actually quite familiar. There have been many others like him who suffered from Bi-Polar Disorder and contributed extraordinary artistic achievements. Kay Jamison wrote a book on this, "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament." I'd like to share with you some of the stories.

Vincent Van Gogh (1853-1890) was an incredible painter and he was hospitalized for depression and eventually killed himself. His "Starry Night" painting is stunning. And it tells a story. It's a dark, foreboding city that he paints. Even the stars overhead are darkened. And the doors to the church are all boarded up. That's what it's like to be depressed.

Mark Twain (Samuel Clemons, 1835-1910): As a boy his younger sister died tragically. This led the family to move away and begin a hard life. He observed slaves being abused. His younger brother died and his father caught pneumonia and died when Mark was a young man. Later he lost his own children to death and this led to bouts with depression, as perhaps his earlier losses were being stirred up. He offered a depressing, but wise analysis of life:

· "The first half of life consists of the capacity to enjoy without the chance; the last half consists of the chance without the capacity."

You can hear him trying to break out of his own depression in words like these:

· "The best way to cheer yourself up is to try to cheer somebody else up."

· "Twenty years from now you will be more disappointed by the things you didn't do than by the ones you did. So throw off the bowlines. Sail away from the safe harbor. Catch the trade winds in your sails. Explore. Dream. Discover."

T S Elliot's depression helped him to write poetry like "The Waste Land" and "Hollow Men" that expressed the disillusionment of entire generation post World War I.

Kay Jamison also identified the famous musical composers Handel, Tchaikovsky, and Mahler as having been depressed. And poets Emily Dickinson, Walt Whitman, and Edgar Allan Poe, who attempted suicide. Ernest Hemmingway died by suicide. Michelangelo was depressed. Hans Christian Anderson, who wrote two of my favorite stories, "The Ugly Duckling" and "The Emperor's New Clothes," struggled with recurring depression.

And current musician Peter Gabriel apparently has had problems with depression. He wrote a powerful song that speaks to the hope that the depressed need, "In Your Eyes."

"In your eyes I see the doorway to a thousand churches."

UNDERSTANDING BI-POLAR DISORDER

We need go over some definitions of terms related to depressive disorders:

Bi-Polar Disorder is diagnosed when someone as one or more manic episodes and one or more major depressive episodes.

Bi-Polar II Disorder is diagnosed when someone has one or more depressive episodes and at least one hypomanic episode. This is easily misdiagnosed as Depression, which is a problem since anti-depressants alone don't treat the mood cycling and instability.

Cyclothymic Disorder is characterized by chronic mood fluctuations between moderate depression and moderate mania. The depressive and manic episodes are shorter and less severe and less regular than in Bi-Polar Disorder.

Mania is an intense burst of energy, creativity, and social ease. In a manic episode the person is euphoric or irritable. In the most severe cases they have hallucinations or delusions. They have at least four of the following symptoms for at least one week:

· Need little sleep

· Talk extremely fast

· Have racing thoughts

· Easily distracted so their attention keeps shifting from one topic to the next

· Feel extremely powerful, important, or great

· Engage in reckless behavior with money, sex, or business deals

A big problem here is that when someone is manic they typically deny that they have a problem and get angry if you suggest that they do.

Hypomania is a milder form of mania with less severe symptoms for as short as four days.

Major Depression is severe and intense depression that's present for at least two weeks. On our public website, NewHopeNow.org, we have a number of self-tests to help people assess their problems including, "Are You D-E-P-R-E-S-S-E-D?" People with Major Depression have most of the following nine symptoms from this test (and they definitely have "Enjoyment gone" and "Sad"):

  • D ifficulty sleeping, eating, or sexually? Are you sleeping too much or not enough? Are you overeating or have you lost your appetite? Has your sex drive diminished significantly or gone into overdrive?
  • E nergy-less? Do you feel tired most of the time? Are you having trouble feeling motivated to do the things you need to do?
  • P essimism about your future? Do you feel negative about what's ahead for you? Do you feel hopeless?
  • R egrets about your past? Do you feel bad when you think about things you've done in the past? Are you struggling with guilt?
  • E njoyment gone? Have you lost a sense of pleasure in your relationships, activities, and hobbies? Does life feel more like a chore than a joy?
  • S ad? Are you experiencing unexpected tearfulness? Do you feel unhappy much of the time?
  • S elf-critical? Are you quick to criticize your mistakes? Are you often harsh with yourself?
  • E mpty? Do you feel a sense of emptiness? Does your life feel mundane or lacking in meaning?
  • D ecisions difficult? Are you having trouble deciding what you need to do in situations? Are you having problems concentrating?

Dysthymia is a chronic and milder depression. It includes many of the symptoms above, but is not as severe or debilitating as Major Depression.

Mixed State is a combination of manic and depressive symptoms occurring simultaneously. An estimated 40% of people who present with manic symptoms also have depression symptoms at the same time. It is believed that Johnnie Carl was in a mixed manic and depressive episode the night he killed himself.

GOD AND DEPRESSION

The heart of the gospel is that God enters our pain. He cares so much, the prophet Isaiah tells us, that in his passion that culminated in the cross he took on our sin and our diseases, to forgive us and to heal us (Isaiah 53:4-5). Listen to how the Apostle John describes the incarnation of God in Christ in his gospel:

"The Word became flesh and made his dwelling among us. We have seen his glory, the glory of the One and Only, who came from the Father, full of grace and truth" (John 1:14, NIV).

Because God has entered into our pain and struggles to love us (in Jesus' flesh and blood, in the Word, in the Spirit, in Christ's Ambassadors) we can do the same for others. The Apostle John calls us to join in receiving and giving Christ's incarnational love in his first epistle:

"God is love. This is how God showed his love among us: He sent his one and only Son into the world that we might live through him. Dear friends, since God so loved us, we also ought to love one another. We love because he first loved us" (1 John 4:8b-9, 11, 19).

John also gives us the shortest verse in the Bible that may be the most profound of all: "Jesus wept" (John 11:35). Jesus wept with Mary and Martha when they were sad and grieving after Lazarus died. And he ministered to many other people who were also depressed, like the woman with the blood disorder, the paralytic at the Sheep Gate Pool, and the self-mutilator who lived in the tombs.

Many of our Bible heroes went through depression: Abraham, Jonah, Job, Elijah, Jeremiah, and David. The Bible is honest about this and shows how they trusted God and found comfort. More than that, the Bible shows how they worshiped God and cared for other people - even while they were depressed. The beautiful message of Scripture that we seek to live every day at New Hope is:

"The Lord is close to the brokenhearted and saves those who are crushed in spirit" (Psalm 34:18, NIV).

At one point the great Apostle Paul and his fellow missionaries suffered so much, were under such pressure, got so depressed that he said:

"We were under great pressure, far beyond our ability to endure, so that we despaired even of life" (2 Corinthians 1:8b, NIV).

The great lesson that Paul learned was that when he cried out to God in his weakness God's grace - his kindness and his abundant life - were sufficient for him and strengthened him to help him grow spiritually (2 Corinthians 12:9). His growth in Christ-likeness was evidenced by his compassion for others. Listen to his words in the beginning of 2 Corinthians. This passage is what New Hope is all about:

"Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God. For just as the sufferings of Christ flow over into our lives, so also through Christ our comfort overflows. If we are distressed, it is for your comfort and salvation; if we are comforted, it is for your comfort, which produces in you patient endurance of the same sufferings we suffer. And our hope for you is firm, because we know that just as you share in our sufferings, so also you share in our comfort" (2 Corinthians 1:3-7, NIV).

We are New Hope Counselors because we too have suffered in life, been comforted by God, and now want to share God's comfort with others.

Our Lord Jesus himself went through his own intense sadness, bordering on despair, in the Garden of Gethsemane as he anticipated carrying our sins and being tortured to death on the cross. He cried out to his closest friends:

"My soul is overwhelmed with sorrow to the point of death. Stay here and keep watch with me" (Matthew 26:38, NIV).

These words have special meaning for us during Lent. I think Jesus might say these same words to us today in response to Johnnie Carl's suicide and in response to our suffering and the suffering of those who contact New Hope:

"My soul is overwhelmed with sorrow to the point of death. Stay here and keep watch with me" (Matthew 26:38, NIV).

As New Hope Counselors we're among those who "keep watch" with Jesus. Jesus urged us to offer welcoming care to strangers: "Whatever you did for one of the least of these brothers of mine, you did for me" (Matthew 25:40, NIV).

LISTEN TO THEIR CRIES

Now if we want to be Christ's Ambassadors then we need to get more tactile with this. It's not enough for us to talk about Bi-Polar Disorder and discuss what the Bible has to say about depression. We need to feel the pain of Bi-Polar Disorder and relate to those who suffer from it. If we want to help people suffering with Manic-Depression then we've got to get inside their skin, to understand what life is like for them. We've got to get incarnational like Jesus did. This is what I've been saying New Hope is all about:

With everyone who calls or chats with us, whatever their hurt or struggle, we want to enter into it and bring the care and kindness of Jesus.

So let's listen to the cries of real people suffering from Bi-Polar Disorder, as shared on http://www.dbsalliance.org/, the website for the Depression and Bi-Polar Support Alliance.

Geena: Taking the Meds and Keeping the Faith

"I was diagnosed with bipolar disorder at age 29. Throughout my entire life I have battled some form of mental illness. During my teen years I wanted to sleep all the time and when I wasn't sleeping I was up all night cleaning my room or reading or doing whatever I could to keep moving, I always had to be moving. I could never shake the feeling that I would be better off not around any more.

I felt like a burden to myself and family. I couldn't hold down a job and my family relationship was the pits. My relationships with guys were even worse. I know now that I was looking for something they couldn't give me. I wanted them to help me be at peace with myself and love myself. I learned a hard lesson that sex does not equal love. Then when I was 28 I was diagnosed with depression and anxiety disorder. The medications I was prescribed for the depression had a bad effect on me. They sent me into a severe manic phase. I had no clue what was happening to me. I really thought I was losing my mind.

Some good came out of a bad manic episode. After a lot of traumatic things happened to me, I ended up in the hospital where I was immediately admitted and diagnosed with bipolar II disorder.

That was about a year and a half ago. I am taking it one day at a time now and trying to keep my head above water. It's not easy some days, but I just keep taking the meds and keeping the faith. And for now that's about all I have the energy to do. I hope to some day to feel 'normal,' whatever that is. Until then I will keep on keeping on."

Linda: "Human Yo-Yo."

"What does it feel like to have this illness? Life feels meaningless. Every night you pray that you will close your eyes and painlessly drift away. Every morning you wake up to another day of silent screaming. Your mind is begging for it to end, but you still care about living.

Even worse, some days you are so crazily happy that you don't know what's happening. Your mind is racing with each uncontrollable thought that enters it. Each new doctor claims that they can fix you. They see your lows, and not your hidden highs. You're a danger to yourself, or so they say. The medicines aren't enough to stop this. They can't control my rapid highs and lows yet. I feel like a yo-yo on God's sick string.

I tell him this. And he hugs me until it hurts for me to breathe. He leaves and I reach for my razor. Resting it in my palm, I feel the cool blade press against my warm skin. Slowly, my fingers loosen their ready position. I need to end this. With one quick motion, I've thrown the razor away. Shaking, I pick up something even more powerful. The phone."

Christina: The First Step

"I believe that I have had Bipolar Disorder since as far back as I can remember. As a child I can remember feeling so angry I wanted to hurt myself and others, I felt so depressed that I wanted to die and believed life wasn't worth living. As I grew up, I suffered psychoses; I would see demons in my room or smell things that weren't there like smoke or flowers. I would have panic attacks all the time and would find myself screaming inside, afraid that people would think I was strange if I did it out loud. I was afraid and sometimes I didn't know why.

I believe that the diagnosis of bipolar disorder is the first step to developing a plan that will save your life, uplift your soul and rescue you from the confusion and despair of this debilitating disorder. If you suspect you have the illness consult a therapist, psychologist, or psychiatrist as soon as you can. If someone you know is suffering from this disorder, please be patient with them and help them find help."

Marilyn: Faith Keeps Me Going

"I had years of psychiatric treatment, and was given almost every diagnosis imaginable. In the last nine or ten years, psychiatrists have told me I have all the symptoms of Bipolar Disorder. I told them I had always experienced more lows than highs. It has been a debilitating disease, because one minute I would be on top of the world, and the next minute, I would be crying and depressed, not able to do anything for myself or anyone else. With every failure or rejection in my life, I tried overdosing on prescription or over-the-counter pills. Right after my father's death, I cut myself all over my arms and legs. Once, I was on an experimental medication and became so anxious I set myself on fire, suffering third degree burns. I was in and out of psychiatric units and hospitals, county and state hospitals and homes.

It is a miracle that I was able to carry out a fairly normal career as a Registered Nurse for 30 years, and that I am now a published writer, never dreaming I could be a writer at all. It's only by the grace of God that I'm here today and able to do any of these things.

I have had all of the symptoms: excessive irritability, aggressive behavior, a temper that still gets me into trouble, racing speech, racing thoughts, and flights of ideas that made me switch topics ten or more times in one conversation. I have been impulsive and had very poor judgment. I've had crying spells and prolonged sadness. I eat more and sleep more. I still get angry very easily and worry about things that I should leave up to God. I get tired and exhausted. I have a hard time making decisions, and sometimes I feel like I should just give up. Today my faith in God keeps me going on a daily basis, and out of the hospital the majority of the time. I know that God restores me - takes my pain and sorrow and sickness and makes me stronger.

My psychiatrist doesn't understand exactly what I am going through, that God will make a way for me where man cannot. God knows exactly what I am going through and will help me endure and overcome it."

Friends and Family

As I said at the outset, for many of us here in this room, myself included, Mental Illness is personal because we have a loved one who is suffering. More specifically, many of you have a family member or friend with Bi-Polar Disorder. Or you may struggle with it yourself. I want us now to take some time to reflect and pray for these loved ones. The way we're going to do this is to imagine that you are this loved one as you consider the statements on the "Bi-Polar Screening Test." We'll take three or four minutes to do this. I'll put on some background music for us. As you read each statement that describes the experience of either mania or depression think and pray for your loved one.

"Bi-Polar Screening Test" from http://www.healthyplace.com/:

 

TREATMENT FOR BI-POLAR DISORDER

Let's make a few comments about the treatment for Bi-Polar Disorder, focusing on the ways that New Hope Counselors can help people with Bi-Polar Disorder and their loved ones.

  1. Diagnoses to begin. Obviously, it's not our role to diagnose Bi-Polar Disorder or any other psychological condition. But we can recommend people get evaluated by a Psychiatrist. We can refer people to organizations that provide information, like the ones I'll mention in a minute.
  2. Medication to stabilize. The key with any severe mental illness is appropriate medications. There are medicines like Lithium, Depakote, Zyprexa, and a number of anti-depressants that help people with Bi-Polar Disorder to function more normally.
  3. Support to heal. People with Bi-Polar Disorder can receive support in psychotherapy, pastoral counseling, support groups, or church groups. And we have referrals for all three on your "New Hope Referrals" list. Being cared for makes a huge difference. The mentally ill need friends more than anyone. We seek to be a caring, friendly influence as we LISTEN.
  4. Skill building to grow. These are gained in psychotherapy or in educational groups led by trained teachers, which we can refer people to. There are many, many skills that need to be learned. Practical things like interviewing for a job, finding housing, making friends. Psychological things like receiving comfort in grief, assertiveness training, moderating moods, using positive self-talk.
  5. Watch to contain episodes. When someone starts to "fly" into a manic episode or "slide" into a depressive episode or "break" into a psychotic episode it needs to be nipped in the bud. These episodes can be damaging to the person's psyche. The quicker the treatment the better. As New Hope Counselors we can urge people to seek help immediately!
  6. Pray to entrust to God. What a privilege it is for us to offer to pray for people, to put them into God's hands, to cry out to God on their behalf, to believe in God's care and help on their behalf. Prayer is powerful.

One of our counselors Mary Lemke took a call from a woman with Bi-Polar Disorder recently and was able to get through to her. This woman was quite upset and lonely. She felt that nobody liked her because she was so overweight. She kept saying that she had no friends. She was even frustrated with her psychiatrist because she felt he didn't listen to her. Mary listened to her and cared for her. She befriended this mentally ill woman. But when she went into brainstorming options for dealing with her situation the woman got more and more upset.

So Mary took a different tack into the cold head wind and put out her sail to catch the wind of the Holy Spirit. She asked if the woman believed in God and she said she did. Mary told her that she did have a friend then - one who would never leave her and never ignore her. It was Jesus. The woman became very calm and peaceful. Mary shared some comforting Bible verses and then asked the woman if she prayed and she said yes. So then they talked about her prayer needs and Mary invited her to pray very specifically about her needs in order to receive specific, concrete answers from God. Then they prayed together.

This woman with Bi-Polar Disorder felt cared for and encouraged by Mary and by God. It helped her get through at least that day and to realize that she wasn't all alone in the world.

REFERRALS

Often the best thing we can do to help someone with Bi-Polar Disorder or their concerned loved one is to offer a referral.

  • "Bi-Polar Disorder: Rebuilding Your Life," is a book by Jim Stout, a pastor with Bi-Polar Disorder who has rebuilt his life and ministers to others with God's help. He will also be a speaker at the International Conference on Care and Kindness, March 10-12.
  • Depression and Bipolar Support Alliance: Information and support groups, 1-800-826-3632, http://www.dbsalliance.org/.
  • Bipolar Disorders Information Center: Information and support groups for those with manic-depression, www.mhsource.com/bipolar.
  • National Alliance for the Mentally Ill: Meetings, information, and resources to support the family of the mentally ill including their 12-week course "Familiy-to-Family," 1-800-950-6264, http://www.nami.org/.
  • American Association of Christian Counselors: Find a local AACC registered counselor or pastor, 1-800-526-8673, http://www.aacc.net/.
  • NewHopeNow.org Articles: "How do I Stop Being so Depressed?" "Help for Depression," "Embrace Your Pain and Be Blessed."

LARRY KING INTERVIEW WITH DR. SCHULLER AND JOHNNIE CARL

Recently Larry King interviewed Dr. Schuller and Linda Carl about Johnnie Carl's Bi-Polar Disorder and his suicide. Some painful and contentious questions were raised. I'm going to briefly identify three of them and offer my view. Then we'll watch the video together and discuss your comments and questions.

"Is Bi-Polar Disorder completely biological?"

As you'll see in the interview, Dr. Schuller refers to Johnny's Bi-Polar Disorder as a "cancer of the emotional system" saying that it was incurable. You get treatment and if you're fortunate it might go into remission. But then it often comes back. This is the way it was for Johnnie.

The truth in this view is that there is a proven biological basis for Bi-Polar Disorder (and other severe mental illnesses) in terms of genetic predispositions and bio-chemical issues, and brain abnormalities. But that does not mean that Bi-Polar Disorder is 100% biological and that there are no environmental factors involved like early child development or trauma.

Stressing the biology of Bi-Polar Disorder is comforting to family members who suffer from false guilt and do all they can to help their mentally loved one. On the other hand, it may trouble those with Bi-Polar Disorder or their children if it leaves them feeling helpless.

"Is suicide a sin?"

"When someone with Bi-Polar Disorder suicides are they responsible for their action? What if they were psychotic? Irrational? In terrible pain?" In the interview Dr. Schuller stressed that Johnnie was reacting irrationally out of a manic episode when he killed himself. Dr. Schuller indicated that he believes that suicide is "very sinful" because of the terrible pain it causes to other people. However, he suggested that Johnnie's suicide was not done from a rational mind and so it wasn't a sin.

The truth here is that we have to distinguish between mental illness and sin, between sickness and morality. They are not the same. But that doesn't mean that there isn't overlap. We have to hold people responsible for their behavior. With criminals who are mental ill we battle back and forth legally in court over determining responsibility. The Bible teaches that sin can be intentional or unintentional (Leviticus 4 for instance). That's really what we're talking about here. I would say that sin can be intended or not, conscious or not, rational or not. The Greek New Testament word for sin simply means "miss the mark." In other words, in your attitude or action you were not holy or wholly; you damaged God, others, or yourself.

We stress over labeling suicide a "sin" because we don't understand sin or forgiveness. So we try to take things out of the sin category in order to assuage guilt or not offend people who don't believe in God. Understanding someone's suicide as possibly being a sin should not diminish our compassion for that person's suffering. As Christians we want to comfort survivors of suicide AND stand for life by stopping the tragic pain caused by suicide, honoring God in both ways. To harp on it being a sin damages the first objective. To whitewash undoes the second goal.

The other problem we have here is trying to find one root cause. All human behavior, and certainly suicide, is complicated and involves more than one cause or motive! In one sense Johnnie was a victim of an illness. In another sense he made a bad decision. In another sense the suicide intervention with the SWAT team didn't work. In still another sense the powers of darkness won a battle, snuffing out a life and hurting many people.

"Can suicide be forgiven? Can the person go to heaven?"

It all comes down to this. Have I received God's grace and mercy? Is God's life flowing through me? Dr. Schuller was unequivocal on the point that Johnnie trusted in Christ and so he is in heaven now. His suicide was not an unpardonable sin. Christ forgives even our future sins when we trust him. This is a very important point.

God alone is the judge of sin and who has their name written in the book of life. He is holy and loving, a righteous Judge and gracious Savior. We need to trust him with this.

And we need to be discerning to individual situations. It should be obvious that when talking with a survivor of suicide that we'd stress the message of God's forgiveness in order to help them with their grief. And when talking with someone who is suicidal we'd focus on the person's responsibility for their behavior. For instance, we wouldn't reassure a despairing person that suicide isn't a sin or God would forgive.


Here is a transcript of the interview: www.assistnews.net/Stories/s05010127.htm

 
     
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