It's OK to Not be OK

Rev. Carlene Appel, MDiv., PC, SC, CERC, CISM, CTP, CDCS, CGP, CCFP

Hey everyone, did you know May is Mental Health Month. So before the month runs out that’s our focus today.

In view of recent mental health tragedies, I picked Depression

Naomi Judd died of a self-inflicted gunshot wound[]

at her home in Leiper's Fork,Tennessee,

on April 30, 2022, at the age of 76. She fought a years long battle with depression accompanied by anxiety, panic attacks, and suicidal thoughts. The medications prescribed to her, including lithium, produced side effects including facial swelling, alopecia and tremors, igniting greater emotional distress.

The very same month, prior to Naomi’s suicide, 3 Young Sailors serving on the USS George Washington in mid-April suicided all within a week.

Depression is different than feeling sad, burned out, or compassion fatigue (caregiver specific). Those are temporary, reverse-able conditions. Feeling sad or down in the dumps is

a normal human emotion. But if it is lasting beyond 2 weeks and you can’t seem to shake it, maybe can’t even drag yourself out of bed, then it’s possible you are depressed. It sucks all your joy out of life bone dry, makes you feel overwhelmed, and for some, not able to function. Depression makes your body hurt, not just your mind. Bruce Sutor, M.D., a psychiatrist at the Mayo Clinic, in Rochester, MN says older people have more physical symptoms than younger people. It shows up as headaches, joint pain, fatigue, sleep disturbances, loss of appetite and gastrointestinal issues. The WHO says it is the leading cause of disability worldwide. Sutor and his colleagues tell primary care Dr.’s to ask about emotional issues when patients present with perplexing physical complaints and start thinking depression.

Younger people, particularly teens tend to present as irritable, withdrawing, not motivated, low energy, low self-esteem, extreme criticism of self, and fixated on past failures.

Women have been thought to be more depression prone than men, but now it’s thought that maybe it just shows up differently in men due to socialization during childhood that displaying vulnerability is not OK. So they present as angry and irritable not sad. This is why I believe it has been such a problem in the First Responder world

which is still made up of more men than women. But we’re working hard to normalize that it’s OK not to be OK. There are people genetically predisposed to depression, depression has been linked to heart disease. Sometimes, it even gets confused with dementia. If you go to the Mayo Clinic website there is a wealth of information there.

On Psy.com you can find the DSM5 Definition

: The diagnostic and statistical manual of mental disorders, fifth edition outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same 2-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.

1. Depressed mood most of the day, nearly every day.

2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

3. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.

4. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).

5. Fatigue or loss of energy nearly every day.

6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.

8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

To receive a diagnosis of depression, these symptoms must cause the individual clinically significant distress or impairment in social, occupational, or other important areas of functioning. The symptoms must also not be a result of substance abuse or another medical condition. Depression is associated with high mortality, much of which is accounted for by suicide. As a result, if you think someone you care about may be suffering from depression it is important to know the warning signs of suicide and to take suicidal statements extremely seriously. An active statement by someone with suicidal ideation might be something like, “I’m going to kill myself,” but other passive statements such as, “I wish I could just go to sleep and never wake up,” are equally worrying. If someone with depression exhibits these verbal markers, encourage them to consult a mental health professional immediately. Depressed individuals also present with irritability, brooding, and obsessive rumination, and report anxiety, phobias, excessive worry over physical health, and complain of pain.

New Specifiers for Depression in DSM-5

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the DSM-5, added two specifiers to further classify diagnoses:

· With Mixed Features – This specifier allows for the presence of manic symptoms as part of the depression diagnosis in patients who do not meet the full criteria for a manic episode.

· With Anxious Distress – The presence of anxiety in patients may affect prognosis, treatment options, and the patient’s response to them. Clinicians will need to assess whether or not the individual experiencing depression also presents with anxious distress.

One of the [KEY] diagnostic features of depression is this kind of self-diminishing, negative thought patterns. Finally, self-harm and suicidal inclinations don’t arise from non-depressive sadness. Those struggling with severe depression may have thoughts of self-harm, death, or suicide, or have a suicide plan. If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline for free at 1-800-273-8255.

Mental Health vs. Mental Illness Columnist Dalia Maeroff who studies psychology and linguistics at UPitt, recently wrote a piece on how so many people use the terms mental health and mental illness interchangeably. She observed students discussing an essay on mental illness & noticed many of them substituted the term mental health for mental illness.

Maeroff attributes this to stigma. Since everybody has mental health it’s safe to say that because mental health is something everybody has And you need to keep it up like a physical health. But as she points out, depression like all other illness of the brain cannot be cured by a walk in the park or self-care day”

I think Naomi Judd is a case in point in this regard. Her family said that she struggled throughout her life with depression. And yet I hear and read about so many simplistic solutions thrown at people suffering from mental illness. “Think happy thoughts.” ”Get over yourself.” “You just need to eat this or to take that herb." St. John’s Wort is one that’s popular, but there are certain medications people take that if mixed with that herb can create major problems. In fact, I learned from an article on AARP.org that St. John’s Wort can render the newest Covid19 antiviral Pavloxid useless. So please talk to your doctor or pharmacist first if you want to try an alternative to medication for depression.

Just because it’s natural doesn’t mean it can’t harm you. Lithium is a single ingredient salt on the periodic table of the elements. Again, one of Nao

mi Judd’s medications. But while it’s a great mood stabilizer among other things, it has some major bad side effects. For one thing if a pregnant woman takes lithium, it can harm her unborn child. If a person takes just a little bit more than prescribed, Lithium can kill them. Drugs.com lists symptoms of lithium toxicity: muscle weakness, twitching, drowsiness, feeling light-headed, mood changes, blurred vision, ringing in your ears, irregular heartbeats, confusion, slurred speech, clumsiness. trouble breathing, or seizures. That’s a 911 call right there.

Speaking of 911, there are certain members of the first responder community, especially, fire, police, correctional officers where depression, PTSI, and other mental illness is still stigmatized and they choose the Naomi Judd option to stop the pain. As a trained first responder Chaplain, I am involved with efforts to reduce the stigma along with my colleagues Dr. Ron Rufo, Rev. Tim Perry, Shawn Thomas, Rich Wistoski, and Dr. Stephanie Conn.

Since I’m a minister & former pastor, let me speak to the Church. And I say this because historically within Christianity we’ve tended to not be very Christlike in our approach to someone who is struggling mentally. Jesus is the one who told the Parable of the Good Samaritan. A woman with a blood disorder, and broke from medical bills touched Jesus’ cloak and was healed. Most significant for this discussion the man possessed by demons in Luke 8. Luke, a physician, described him as living naked in graveyards in tombs, frequent grand mal seizures so bad he broke strong chains used to restrain him. After Jesus called out the demons, Luke says the next time people saw this guy he was “fully dressed, sitting at Jesus’ feet, and in his right mind.”Luke 8:27-39.

So if this is what God did when He became one of us, why has that not been our model? Why is it often still a stigma in too many of our Houses of Worship?. Thankfully, it is changing but there are still way too many churches where they continue to shoot their wounded. By that I mean, the expectation is that if Jesus is your Lord and Savior, you should always be happy. J.O. Y. Jesus, Others and last and least You. Mention depression and you’ll be bombarded with either simplistic answers and platitudes from you need to pray more, fast more, read your Bible more. Or we have those who prefer to imitate Job’s so called “friends.” Job was a very righteous man who lost it all and instead of balm for his depression, he gets 3 lectures. All essentially telling him to "Repent of your sins, because obviously you must have really screwed up and ticked Yahweh off."

Thanks Job’s “friends” for demonstrating why people should avoid Church like the plague. Churches are supposed to be a place of mercy, grace, forgiveness, and healing. One of the lessons I see from how Jesus dealt with the demoniac, is that if you want to make a way for someone to reject sin in their life, you gotta remove the barriers blocking the way first.

Clinical depression is an illness of the brain, and there are a growing number of ways to treat it, from new therapies, to medication, diet, and more. I really do see progress within the Christian Community. Churches are training lay people to provide acute help as Mental Health Coaches. Professional Christian Mental Health Associations are providing training to laypersons. Larger churches have Pastoral Counselors on staff, church members are getting educated about mental illness.

Again, Clinical aka Major depressive disorder is due to brain Illness. I want to circle back to Naomi Judd. She wrestled with depression most of her life, and she was in a lot of pain mentally, physically, emotionally and spiritually. That’s really a hard place to be. There was a lady at my Church who’s since moved out of state she went through a lot of mental illness and she was a speaker for NAMI. One of her things was educating churches so that we can help people discover better options than feeling like the only way to stop the pain is is to pull a trigger or overdose, hang themselves, or step in front of a train. Crisis numbers are listed at the end of this article.

There is help for depression. Please don’t give up.

Many people care about you and God loves you. So do I.

Later!

The Rev.

If you’re feeling suicidal or just need to talk, call the National Suicide Prevention Lifeline

for free at 1-800-273-8255. (1-800-273-TALK)

NAMI- nami.org/helpline

VA 24/7 Veterans Crisis Line: 1-800-273-8255 Press 1

TXT 4 HELP----Teens in Crisis Text the Word “safe” & your current location to 4HELP (44357)

FIRST RESPONDERS struggling with a mental health crisis text “BADGE” to 741741.

SAMHSA (Substance Abuse and Mental Health Services Administration National Helpline). (800) 662-4357