Tag Archives: health

Chronic pain and the christian life


Over at the Biblical Seminary faculty blog, I posted this entry about the matter of chronic pain for the Christian and ended with a few brief thoughts as to what faith looks like when you suffer with a chronic condition.

You will note that in the post I do not mention anything about healing. I resisted that discussion for the time being (good as it is) because I think it so often adds to the sufferer’s experience of pain (e.g., “now I carry the extra burden of wondering why I haven’t been healed and possibly your judgement that something is wrong with my faith”) AND minimizes the current experience of pain.

On Friday, Joni Eareckson Tada spoke about the fact that she still is stopped by people who tell her they pray she will get up out of her wheelchair and walk. I imagine she is polite but her answer was that she would not want that prayer answered now. She can save walking for heaven. Today, she has a more important job to do, and her paralysis is being used by God to refine herself and redeem others.

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Filed under Biblical Seminary, Christianity, suffering

Ken Tada: Breast cancer from the husband’s point of view


Last night I had a short but sweet conversation with Ken Tada. That would be Joni Eareckson Tada’s husband. Joni and a few others were presenting yesterday at a Biblical Seminary event. At the Q & A, an audience member asked how we all could pray for Joni and Ken. Ken’s answer was to tell us that in 2010, Joni was diagnosed with breast cancer. She had treatment and now has gone 2.5 years since surgery and chemo. He asked that we pray for continued good health in regards to cancer. He mentioned the important goal of making 5 years without a reoccurrence.

As a fellow husband of a breast cancer survivor, I could relate well to his prayer. We just hit our 3 year anniversary. During our conversation we discussed how such a diagnosis and ensuing suffering brings life into crystal clarity. What is important (relationships, time together, worship, small things like listening to the birds, etc.) and what is not (writing/speaking opportunities, following the news, public affirmation, career advancement) becomes so evident to us. It also taught us both (Ken and I) what vows mean. Now, I would have thought he already understood that being married to Joni. I suppose he did. However, new forms of suffering remind us of what God’s love is like for us.

Last night Joni said that suffering is used by God to purify us, to remove those things that are not from him. I agree. It does so in both the one with cancer as well as the husband.

He and Joni have a new book coming out in April. I saw a copy of it last night. Looks like a good read!

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Filed under breast cancer, marriage, Relationships, suffering, Uncategorized

Why is some trauma complex? A helpful distinction from Judith Herman


Counselors talk about trauma as if all traumas lead to traumatic reactions. They do not. Some people have significant distress from what might be considered slight traumatic experiences (surely an oxymoron!) while others appear not have any negative or ongoing reactions to very large distressing events.

There’s another problem. We sometimes talk as if all traumatic reactions are the same. This is also not the case. While the symptoms of posttraumatic stress disorder (PTSD) are well-known to many (i.e., intrusive re-experiencing of trauma experiences, emotional numbing and other attempts of avoiding memories or triggers, and hypervigilance), you can find counseling students and practitioners who are less aware of a cousin of PTSD: Complex Trauma.

Defining Complex Trauma

I’m reading Treating complex Traumatic Stress Disorders: An Evidence-Based Guide, edited by Christine Courtois and Julian Ford (Guilford Press, 2009). This is an excellent text if you are interested in exploring the symptoms, neurobiology, and treatment protocols for complex trauma. In the foreword, Judith Herman helps the reader clarify the main difference between regular and complex trauma

These days, when I teach about complex PTSD, I always begin with the social ecology of prolonged and repeated interpersonal trauma. There are two main points to grasp here. The first is that such trauma is always embedded in a social structure that permits the abuse and exploitation of a subordinate group… The second point is that such trauma is always relational. It takes place when the victim is in a state of captivity, under the control and domination of the perpetrator. (xiv, emphases mine).

For trauma to become complex one needs to experience the trauma at the hands of those who are most perceived to control a social unit (family, community, etc.). It needs to be repeated and woven into the fabric of distorted relationships. You can see that prolonged abuses experienced as a child prior to development of an understanding of the world and of the self would have more devastating impact than an unfortunate and distressing event that happens as an adult. If I experience a horrific accident and an unexpected attack by a stranger, I would not, usually, begin to feel unsafe amongst friends and family. I would likely continue to trust them even as I might not trust the larger community. However, if I experience repeated abuse by a teacher, a parent, a relative, a church leader as a young child, I do not have the prior experiences of safety to rely on and thus, I am likely to experience all of the symptoms of PTSD and then some more.

What More Symptoms?

Courtois and Ford give a cursory description of complex trauma on the first page of the book,

…involving traumatic stressors that (1) are repetitive or prolonged; (2) involve direct harm and/or neglect and abandonment by caregivers or ostensibly responsible adults; (3) occur at developmentally vulnerable times in the victim’s life, such as early childhood; and (4) have great potential to compromise severely a child’s development.

Adding to the typical symptoms of PTSD, complex trauma victims also struggle to regulate emotions, impulses, somatic experiences, consciousness, and evidence significant distortions in views of the self and others leading to difficulty forming trust relationships and finding meaning in life and faith.

Those interested in learning more about the current thinking on complex trauma conceptualization and treatment may find this book useful. Others may wish to check out the latest articles at www.traumacenter.org, one of the leading centers in the country focused on the problem of trauma.

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Filed under Abuse, counseling, counseling science, counseling skills, Post-Traumatic Stress Disorder, Psychology, Uncategorized

Book Note: Linkages between stress, inflammation, and mental illness


I am in the process of clearing my desk of semester debris. Well, truth be told, I am in the process of clearing a portion of my desk from said debris. The rest will have to wait. In the process, I came across a book I’ve been meaning to read since the dept. purchased it for me: The Psychoneuroimmunology of Chronic Disease: Exploring the Links Between Inflammation, Stress, and Illness (APA, 2010).

Before you all stop reading, it really is an important work! You should care if you are someone experiencing high levels of stress or if you counsel those who do. AND, there IS an answer (you won’t like it!) that can help given at the end of this post.

Yes, it is very technical. You can’t skim this book easily unless you read only the chapter summaries (not a bad idea!). However, I find it very interesting to read about how well-connected (too well!) our minds are with our bodies. Here are a couple of book highlights

1. Chapter one: Stress activates primary and secondary responses that may actually increase our vulnerability to disease. Secondary? Examples given include alcohol abuse, poor diet, non-compliance with treatments. Primary? Your body does a couple of things in reaction to stress. First, your sympathetic system starts looking for inflammation. Immune cells look for an injury. You have more glucose available to burn and cortisol increases which also works to activate anti-inflammatory responses. Inflammation is the problem (a “rapid and nonspecific response to danger”). Too much inflammation? damaged tissue. Too much anti-inflammatory response? Damaged tissue. Those with depression may have become less sensitive to cortisol and so end up with lots of non-specific inflammation. Maybe this is why depression hurts so much!

2. Chapter 3: Poor sleep has serious health consequences, especially concerning chronic diseases. One study indicates that disordered sleep has a direct link to type 2 diabetes, independent of age and body size. Individuals with sleep apneas have a greater production of inflammatory bio-markers. Women may be at greater risk for cardiovascular diseases due to sleep problems than men. One problem (sleep problems) begets the other (inflammation) which creates a vicious cycle.

3. Chapter 4: “Western diets typically contain an abundance of proinflammatory omega-6 fatty acids and are low in anti-inflammatory omega-3s.” (p. 96). In other words, dietary fish oil helps promote healing and may lower symptoms due to inflammatory diseases. More fish oil, less vegetable oil.

4. Chapter 5: Links between stress, depression, PTSD, hostility and inflammation. Each of these things increases inflammation, increases sleep disorders which in turn…(you get the picture).

Okay, does anything help l0wer stress and increase healthy immune system functioning? This is the answer I promised at the top of this post. Are you ready? It is so simple you will hate it!* (that will be something to explore at a later date–why do we resist the things we CAN do to help our situation?)

1. Diet. Having a better (lower) ratio of Omega-6s to Omega-3s (more cold water fatty fish) seem to lower rates of depression. Higher Omega-3 consumption predicts lower suicidality, lower depression, and bipolar disease. It appears these amino acids help stop the overactive inflammatory response caused by repeated stress.

2. Exercise. It will initially raise inflammation markers (hence why many with RA feel that any exercise creates more pain), but later lower it if continued on a regular basis.

3. Counseling. Cognitive-Behavioral social support interventions have shown to reduce the inflammation effect by lowering stress. be effective in doing just that.

So, encourage your stressed clients or friends (even better, do it with them) to eat well, exercise (just walk!) and seek social support. In doing so, they will find relief from inflammation and the effects on the mind and body. I guess it is time for me to get up from this desk, skip the doughnut, and walk up to the library for a bit of exercise. On the way, I should stop by a colleague’s desk and get him to come with.

—–

*Simple? Yes. Quick fix? No. Sure bet to solve all our problems? Absolutely no.

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Filed under counseling, counseling science, counseling skills, Depression, Psychology

Birth trauma? Maternal PTSD?


The August 5, 2008 Wall Street Journal ran a short article on a new postpartum illness akin to PTSD. The author, Rachel Zimmerman, reports that though”PTSD is commonly associated  with combat veterans and victims of violent crimes, but medical experts say it also can be brought on by a very painful or complicated labor and delivery in which a woman believes she or her baby might die.”

While Postpartum depression has received more attention of late (the paper reports the NIH statisticof 15% of mothers affected), there is some speculation that as many as 9% meet criteria for PTSD, and most of these who have given birth to children with serious and immediately life-threatening health issues. These find themselves re-experiencing the traumatic birth, avoidance of places that bring these flashbacks up, and persistent symptoms of increases arousal and hyper-vigilance. Per the article more states are now trying to screen and/or education new moms to this problem. NJ requires all mothers to be screened for depression prior to discharge.

As an adoptive father, I recall well the anxiety and hyper-vigilance of bringing home our first child when he was 4 days old. I didn’t sleep for days, or so it seemed. I worried about his breathing. I felt like I had lost my independence for the rest of my life (I was the stay-at-home dad at the time). It was an overwhelming time for us. And we were healthy, he was healthy, and we were not recovering from the trauma of even a normal birth.

So, I can well assume that if you add all of the normal birth trauma plus medical crises, helplessness, etc. that these experiences can result in symptoms like PTSD. I would suspect, however, that for most people these symptoms would dissipate quickly, especially if the medical crises passes in a day or two. So, we should be careful not to overreact to transitory symptoms and medicate everyone with a struggle. If it is PTSD, then the symptoms should persist for more than a month.

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Filed under Anxiety, Depression, Post-Traumatic Stress Disorder, Psychiatric Medications, Psychology

When your brain lies to you


Ever were sure of some “objective truth” only to find out that you are wrong?

My dentist told me this week that my brain isn’t telling the truth. After installing a crown on a lower tooth, he asked me how it felt. I stated that the crown was too high and was touching first in my bite. He checked it, concurred, and made some corrections. Then he asked me how it felt. It was better, I thought, but still too high. He checked again with something that tells him how my bite is coming together and that is when he told me my brain is not telling the truth. He stated that the the nerves are sensitive around this newly rebuilt tooth and so it pays attention to that feeling and ignores the rest of the bite sensation.

I’m not surprised. Our brains don’t always tell us the truth. People have phantom pains on amputated legs. Our eyes play tricks on us and so we “see” what isn’t actually there.

Isn’t it hard to accept that some of what we think or perceive isn’t real? It can be quite unnerving.

What about our emotions, assumptions about others, about what God wants us to do? What about our ability to correctly perceive these things? Does our brain/heart lie to us here as well? Have you ever thought someone was mad at you and found out later that it wasn’t the case? Did you ever experience panic over something that turned out not to have happened?

Where are you inclined to hear and believe lies? How did you come to realize you perceived wrongly? What have you done to try to counter these lies, to train yourself to hear the truth?

As to my tooth, I want to believe my dentist. He has a good track record for being right. But right now my mouth says something is wrong. I’m going to make an effort to either ignore the sensation or be mindful of the interesting way the brain works with new information. In a couple of weeks I may change my mind. Maybe my bite is different AND the crown isn’t too high.

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Filed under Psychology

Are counselors and psychologists an impaired lot?


We’re closing in on the last of the school year. Two weeks to go. Tonight in our ethics class we’ll be discussing the matter of abuse of power, impaired clinicians, and similar issues. In the world of counseling we discuss the problem of impaired counselors/students/trainees when we talk about those who,

(a) do not have the requisite skills, 
(b) have character/attitude deficits, or
(c) reactions to current crises,

AND are unwilling or unable to repair the situation.

First, we ought to be aware of those who are attracted to being counselors. Jeffery Barnett, et al, report the following data from other studies (as cited in the 2007 Professional Psychology: Research & Practice, 38(6), pp 603-612):

  • 70% of female psychologists had been either sexually or physically abused as children
  • 33% of male psychologists report the same
  • 33% of psychologists report being abused as adults
  • They feel the effects of these difficulties (and other family crises) just as non counselors
  • They may be less likely to get help due to knowledge and professional identity
    • 60% acknowledged being significantly depressed during some point of their career
    • 29% reported being suicidal at some point
    • 4% had made suicide attempts

Gizara & Forrest (2004 Professional Psychology: Research & Practice,35(1), pp 131-140) reported supervisors experiences of trainee impairment in APA accredited internships (doctoral level). Many of the supervisors had a hard time defining impairment in counseling but had sort of what I call the “I know it when I see it” mentality. What they often described were the disruptive, persistent relationalconflicts that are obvious to most. They did identify that it is hard for supervisors to address these matters because they (a) are trained to be empathic and to try to save everyone, and (b) not wanting to deal with conflict, destroy a career, or make oneself vulnerable to attack that they are holier than thou.

But, I noticed not much discussion or research regarding the one who doesn’t have obvious abrasive relational skills who is prone to using clients and others to make themselves feel good. This kind of person is dangerous not because they disrupt the counseling center but because they are so well liked that they make others overlook “minor” ethical infractions. Further, the person is rarely cognizant of their using others for their own sense of well-being.

To answer my question. No, I don’t think counselors are an impaired lot–at least any more than others. If we are aware of what drives us to be counselors (the good AND the self-serving), are willing to be counseled, discipled, held accountable, etc. (are willing to be transparent), and see our work as God’s first, then I think we are rather a safe lot.

Watch out for those of us who think we have arrived or no longer need teaching. I’m reminded of Aslan’s question to Prince Caspian at his coronation:

Aslan: Do you feel yourself sufficient to take up the kingship of Narnia?

Caspian: I-I don’t think I do sir. I’m only a kid.

Aslan: Good, If you had felt yourself sufficient, it would had been a proof that you were not.     

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Filed under Abuse, biblical counseling, christian counseling, christian psychology, counseling, counseling science, counseling skills, Psychology, Relationships, self-deception, teaching counseling