Wednesday, June 17, 2009

Theological Implications of Anxiety

Man lives an anxious existence. After rebelling against God and paradise man’s existence changes radically: “cursed is the ground for thy sake; in sorrow shalt thou eat of it all the days of thy life; Thorns also and thistles shall it bring forth to thee; and thou shalt eat the herb of the field; In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return” (Gn. 3:17-19). Ever since the fall mankind has been violently cast into a world of darkness, terror, death, and decay. Humanity, due to the violence of sin, hides from God and is terrified of him (Gen. 3:8). Man also continues to suffer the confusion of Babel. We are confounded by the world around us which is often unintelligible and completely lacking in compassion, understanding, and God’s truth. We are cast about, confounded, misunderstood, and confused. Or as one of my favorite songwriters Ray Lamontagne sings, "Trouble...Trouble, trouble, trouble, trouble trouble been doggin' my soul since the day I was born. Worry...Worry, worry, worry, worry worry just will not seem to leave my mind alone"

There is no hebrew or latin word for panic as apart from fear or terror (transliterated in the Hebrew as yirah). The word “panic” is derived from the Greek word “panikos,” “pertaining to Pan,” the god of the darkness of the woods who arises deep panic and fear driving poor creatures into irrational behavior or suicide. Panic often accompanies hysteria (hysterikos) or fear, like that of the men whom having been exorcized by the ministry of Jesus sat afraid at his feet (Lk. 8:35). Episodes of panic and hysteria have historically been attributed to supernatural forces or demonic affliction. Only since Sigmund Freud have panic disorders been more thoroughly partitioned off from any possibility of spiritual affliction. The diagnostic category of “anxiety neurosis” was first postulated by Freud in a paper entitled, “On the Ground for Detaching a particular syndrome from Neurasthenia under the description Anxiety Neurosis (1894).” Freud’s description of anxiety neurosis is similar to today’s DSM-III description of panic attacks, which both include disturbances of heart rate, sweating, fear, vertigo, etc. What ought not come as a surprise is that Freud attributes panic attacks to sexual impotency and frustration, whereas today’s medical establishment attributes panic disorder squarely into the all-encompassing reach of “bio-chemical imbalance.”

Anxiety is now the number one emotional problem of our day. For women, panic anxiety is the number one mental-health problem of our day. Dr. Archibald D. Hart attributes the rise of panic disorders to the supercharged pace of American life, “High adrenaline, caused by overextension and stress, depletes the brain’s natural tranquilizers and sets the stage for high anxiety.”[1] The adrenaline-anxiety connection is central in Hart’s analysis which may well be remedied by tranquilizers or more practical means: exercise, diet, etc.

Though I am sympathetic to depression and anxiety disorders, we need to speak honestly about the world and the human condition. As a necessary disclaimer to those hypersensitive about cleaving to psychotrophic medications, I must say that we ought to make an allowance for medications that are prescribed for those suffering from certain debilitating illnesses that inhibit daily functioning, such as the inability to get out of bed. Christians are not Christian Scientists or Scientologists who deny the blessings of modern medicine, and therefore we must prayerfully consider and weigh out the costs and benefits of SSRI’s, tranquilizers, MAOI’s, and Tricyclics.

Though man is formed in the image of God as the crown of His creation, the fall has had consequences on the body. Man in his rebellion against creator and creation has exchanged the truth of God for a lie (Rom. 1:25) and now bears in his body the marks of sin, despair, depression, terror, panic, and ultimately death (6:23). Sin itself is a spiritual as well as biological and chemical phenomenon. When considering how to deal with depression and anxiety, which go hand in hand, we need to reconcile ourselves with the most fundamental truths concerning man’s existence. First, man is born in a state of a “bio-chemical” imbalance – which is the norm and not the exception, “They meet with darkness in the day time, and grope in the noonday as in the night” (Job. 5:14). He is not the “noble savage” envisioned by Jean-Jacque Rousseau, who is born in a marvelous light, who in his essence holds an intrinsic goodness in perfect communion with the natural world. There is not a natural bio-chemical harmony with God or with the rest of creation. In the fallen and confounded state of man, which despises God and closes himself off from the neighbor, the inward and outward retreat of man from the font of life is a neurotic and thoroughly dangerous venture. Everyday normal life is lived in tension – in disorientation – a continual crisis of faith – lived out in paradox, doubt, and affliction – mediated only by God’s promise, “I am the Lord your God, and you are my people.”

While being sympathetic to those suffering from debilitating illnesses, we must also make an allowance for anxiety as a discipline. Anxiety is experienced in fear, disorientation, along with a range of physiological consequences – increased heart rate, sleep disturbances etc. Or as Luther wrote, “The pagan trembles at the rustling leaf. The uniform teaching of Scripture is that fallen men are fleeing from God.” In man’s fleeing from God he has run headfirst into a pit of darkness and despair in which he can find no deliverer – not in his idols, work, or imagination. He must be rebuked, turned, rescued, and returned to the font of life from whence he came, “Blessed is the man whom God corrects; so do not despise the discipline of the Almighty,” (Job. 5:17).
I have researched and written about the history of antidepressants medications and the structural involvement of the big pharmaceutical firms in DSM here.

[1] Hart, Archibald D. The Anxiety Cure: You Can Find Emotional Tranquillity and Wholeness. Nashville, TN: Word Pub, 1999, p. vi (preface).

Monday, June 8, 2009

Pastoral Counseling to Those Mourning Death

It is the solemn duty of every pastor to visit the sick and dying and attend to those grieving at the passing of loved ones, Matt. 25:36-40; Ezek. 34:1-16, James 5:14,15; Is. 38:1; 2 Cor. 1:4; 1 Thess. 2:11. Death is the final enemy and its victory is surely won in Christ Jesus whom swallows up death with His own death. The church is bound up in Christ and shares in His death and resurrection. Counseling those grieving involves keeping them in this gospel – this hope and ultimate truth that defines all history. In addition to this confession, pastoral care and counseling must closely observe the daily grieving process and ensure that the most basic needs are met with the help of the community.

Pastoral care must make an allowance for the disorientation of death. Disorientation may be permitted to stand as a natural processing of the trauma. Pressuring despondent mourners into a premature state of resolve only inhibits true healing. Though the Pastor is to bring hope and comfort for those suffering, his work is not to forcefully move someone from a state of disorientation to a state of orientation. The pastor proclaims the hope of the resurrection and eternal life in Christ and encourages the bereaved to draw strength from Christ’s word and sacraments in the fellowship of the congregation. Orientating the grieving toward Christ’s saving word does not necessarily result in the state of orientation that is naturally desired by those providing care.

When dealing with tragic and unexpected deaths, those grieving are in most cases experiencing a barrage of spiritual affliction, including anger, despair, guilt, and the deepest sort of physical suffering. There are deep fractures in every human relationship and the interruption of an unexpected death lobs a debilitating series of questions and doubts toward the grieving family, “is he is heaven?” or “did he know how much I loved him?” Guilt accompanies those whom deeply regret withholding their love prior to the loss. There are many things not said – important fractures not resolved. The grieving may cry out, “If only I had…said this or that before he died.” These fractures and the resulting disorientation must not be artificially patched over with any common human wisdom. It is only God’s forgiveness and great creative work that will grant the only true balm and healing. Pastoral care and counseling must proceed from this bold confession, that Christ alone makes all things new, healing our wounds with his, actively attending the brokenness and anxiety of human relationships and the terrible interruption of death.

Those helping people grieving with the death of a loved one ought not provide explanations for the tragic death and why it may have occurred. It is often a common reaction to desire to provide reasons for the tragedy, how it may be “God’s will,” attempting to feverishly recast the tragedy into something that may not be so tragic after all. This is a natural human reaction experienced by those who want to comfort someone grieving. It is difficult to encounter suffering and takes a sort of discipline to refrain from offering false hope and empty therapeutic measures. Though the motivation may be pious, this sort of theological speculation is inhumane as an authentic address of pastoral care. The old Adam – the man of sin - always wants to “make sense” of his world – assign meaning to every phenomenon in the universe as it relates to God’s omnipotence and sovereign will. This is a mistake in counseling those grieving over death, or in any spiritual situation. The church’s theology does not decipher God’s inner workings and precise meaning and motivation for each tragic and horrifying event that takes place on a day to day basis.

A loving and pastoral counsel to the grieving must avoid such platitudes and trite explanations as “Everything will be ok,” “At least he didn’t suffer,” “you’ll get over it,” and “I know how you feel.” Though all these statements contain certain elements of truth and the possibility of therapeutic value, they somewhat trivialize the event of death and seek to “move beyond” it or transcend it, thus passing by its significance. This will be a common temptation by caregivers to provide such empty admonitions about death in a desperate attempt to evade the real concerns of those grieving, particularly, “where is he now?” When Saint Paul writes that “all things God works for the good” (Rom. 8:28), he is not speaking in some vague stoic fashion about God’s sovereignty in the universe. He is speaking only about the resurrection of the dead and the life to come through the atonement of Christ and the outpouring of forgiveness flowing from His cross. That “all things work together for good” is not some new age “power of positive thinking” spiritual tip to navigate through tough times in life. All things working together for good is a summarizing commentary on the atonement and the dialogical grieving between God and His creatures, whom both long to see each other as was originally intended, “yet in my flesh I will see God; I myself will see him with my own eyes” (Job. 19:26-27). 

In a post-Christian culture, it is common to deny death altogether, or oppositely to naturalize it as if it were no different than the withering and dying of a flower. Care for the those mourning ought not compromise their confession in order to bypass the tough questions about God, sin, death, faith, and grace. What is true is that death was not built into God’s creation; death violates human life and is completely and utterly devastating. Human sin caste the world into discord, violence, strife, and ruptured the relationship between creator and creature and man with his fellow man. The silence following death speaks of the bitter finality caused by the rupture of death on this side of eternity. This brokenness will not be restored on this side of heaven. God’s dear Christians whom receive him are planted in heaven. Saint Paul writes, “So it is with the resurrection of the dead. What is sown is perishable; what is raised is imperishable. It is sown in dishonor; it is raised in glory. It is sown in weakness; it is raised in power. It is sown a natural body; it is raised a spiritual body” (1st Cor. 15:42-44). The so called dignity and worth of dying saints is not established by any certain quality which exists in and of themselves, however much we would like to claim otherwise. The loveliness of a man or woman is granted by God’s spoken word which poured out man like milk, clothing him with skin and flesh, bones and sinews (Job. 10:11). Jesus is the very source and fountain of life from which all life does proceed. Christ does not improve life or modify it but speaks it into existence. Therefore the dignity of dying lies in the fact the man is a spoken Word by God, breathed into existence by him. The loveliness of death comes only from Christ’s advent – His incarnation into the world to rescue humanity from the deadly curse of human sin.

The fracture between God and man and then between man with his fellow creatures in open rebellion cannot be closed by any act or discipline of man but only by God. Pastoral counseling must insist that God will bridge the gap of death and reunite lost inhumanity solely by his work on the cross, apart from any performance on man’s part. God’s baptizing and holy word of forgiveness is what breaks through and unites humanity forever with him in the great halls of heaven. From the starting point of God’s action, practical advice may be given to sustain the mourner in his time of grief.

Encountering the death of another involves a physical loss. The interconnectiveness of human relationships is not just communicative and oral but physical. This is not just true for married people and family members but even friends and acquaintances. We long for the body and person of another, the physical proximity of another. This is not at all something to be ashamed of. The mourning process often involves physiological consequences that are particularly adverse to the body. The physical trauma often involves decreased functioning in such basic activities of eating and sleeping – whether they be either severely neglected or over indulged. While pastoral care may support making certain allowances for the natural disorientation of death, it must take a more proactive stance toward meeting the most basic demands of the body. Healthful eating and sleeping must not be compromised in the grieving process. For this reason pastoral care may involve ascertaining that the grieving person be surrounded by a network of support that can keep a watchful eye on such daily functioning. If such a network of support is not present, it is not beyond the pastor’s pay grade to intervene and establish the needed network by way of willing servants in the church community.

The intensity of the grieving is often highest during the initial weeks following the funeral. Though the funeral is often viewed as the most emotionally intense period of grieving and separation, it is much more so the time following, particularly for those closest to the deceased. The time between the death and funeral is usually a surreal and peculiar experience that often times cannot wholly grasp what has happened. The flooding of sympathy from family, friends, co-workers, and acquaintances keeps the mourner occupied with the communal implications caused by the death and moves into a sort of autopilot reaction. Making plans and arrangements for the funeral further occupies the mourner with responsibilities that temporarily takes attention away from coping with the totality of death and its meaning. When the funeral has passed and the last sympathy card opened the mourner returns to daily life as it was before, and only then encounters the most bitter distress of death.

It is in this stage of grieving that pastoral care and counseling is most dearly needed. Pastoral counseling may, contrary to alternative theologies and psycho-therapeutic techniques, encourage a person to be vulnerable to their pain and anger. Christians do not need to “take control” of the situation and willfully change their mood or perspective upon the deep rupture of death. Pastoral counseling may, however direct the frustration toward the one whom can truly mediate through the rupture of death. For this reason Dr. Richard Eyer writes, “It is a goal of pastoral care to encourage complaint to God, even in the form of anger. To whom else can we go when really frustrated and frightened than to God? God can handle it.”

Therefore, pastoral counseling may facilitate a prayer life that directs complaints and even anger toward God. Contrary to pietistic notions of prayer, Christians are not called to always speak to God in carefully premeditated delicate language. Mourning and the prayers of frustration and sorrow may be a shriek of pain or anger that may very well sound impious and demonic. God desires to hear not just pious spiritual platitudes when times are good but truly longs for receiving us in great love even in our most angry and bitter estate. God invites us to challenge him in delivering His promises and hold him accountable (Ps. 31:2). Those grieving over the death of a loved one cannot make a harmonious synthesis of God’s promises of everlasting peace while He has simultaneously taken a saint away even in a most tragic death. Christians need not be forced into a stoic submission to God’s will, but are rather invited to consider the contradiction between the peace of God and his hiddenness in that he ends life in ways that are far from what seems peaceful or merciful.

Pastoral counseling ought to gently point to the sound and word of lament, that weeping may become a song of praise. Besides encouraging spontaneous ex corde (from the heart) prayers pastoral care ought to provide a theology of lament and hand over its voice to those suffering. Encouraging use of the psalter and the church’s liturgy is a great blessing for God provides us with the very words of lament. Psalms of lament and such liturgical treasures as the litany can explicate the condition of the grieving human heart more accurately than our own internalized analysis of what we think we may be experiencing when encountering such terrifying loss. Pastoral counseling to those dealing with death must also make frequent use of the sacred hymns of the church. Before I “talk things” out with mourners I must first sing them and pray them. The more I mine the riches of the Lutheran hymnals it becomes much more evident that single stanzas of Lutheran hymnody can simultaneously diagnose the despondent human heart and meet it with a pure preaching of the Gospel that would exceed any manufactured wisdom that I may manufacture on my own. It would be foolish not to make constant use of singing and praying the timeless hymns of the church to those who are dealing with the death of another. Two hymns that stand next to each other in the Lutheran Service Book provide an inexhaustible resource for consoling the grieving, “Entrust Your Days and Burdens,” and “In the Very Midst of Life,” (LSB 754-755). It is not enough to be familiar with these hymns. Internalizing them and speaking them as prayers recasts the heart and mind into the living, breathing doctrine of Jesus and His work.

When we press into God for mercy and healing we hear Christ’s Holy Absolution, “I forgive you all your sins,” we hear the words of the last day and are made members of heaven whom will be resurrected from the grave. Where there is forgiveness there is life, salvation, and the resurrection of the dead. The rupture of death is calmed and stilled by this Gospel and nothing will be lacking. The fissures caused by death and the anxieties that come when dealing it are repaired by this life saving word.

I have dealt more in depth with suffering in Pastoral Care of Lament HERE.