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Posts tagged ‘wise decision-making’

Psychiatric Meds: Should I or Not?

SOURCE:  Brad Hambrick/CareLeader

“Pastor, should I take psychiatric meds?”

Let’s begin this discussion by placing the question in the correct category—whether an individual chooses to use psychotropic medication in his struggle with mental illness is a wisdom decision, not a moral decision. If someone is thinking, “Would it be bad for me to consider medication? Is it a sign of weak faith? Am I taking a shortcut in my walk with God?” then he is asking important questions (the potential use of medication) but placing them in the wrong category (morality instead of wisdom).

 Better questions would be:
  • How do I determine if medication would be a good fit for me and my struggle?
  • What types of relief should I expect medication to provide, and what responsibilities would I still bear?
  • How would I determine if the relief I’m receiving warrants the side effects I may experience?
  • How do I determine the initial length of time I should be on medication?

In order to answer these kinds of questions, I would recommend a six-step process. This process will, in most cases, take six months or more to complete. But it often takes many months for doctors and patients to arrive at the most effective medication option, so this process does not elongate the normal duration of finding satisfactory medical treatment.

Having an intentional process is much more effective than making reactionary choices when the emotional pain (getting on medication) or unpleasant side effects (getting off medication) push a person to “just want to do something different.” With a process in place, it is much more likely that what is done will provide the necessary information to make important decisions about the continuation or cessation of medication.

Preface: This six-step process assumes that the individual considering medication is not a threat to self or others, and is capable of fulfilling basic life responsibilities related to personal care, family, school, and work. If this is not the case, then a more prompt medical intervention or residential care would be warranted.

If you are unsure how well your church member is functioning, then encourage him to begin with a medical consultation or counseling relationship. If he would like more time with his doctor than a diagnostic and prescription visit, suggest that he ask the receptionist if he can schedule an extended time with the physician for consultation on his symptoms and options.

Step 1: Assess life and struggle

Most struggles known as mental illness do not have a body-fluid test (i.e., blood, saliva, or urine) to verify their presence. We do not know a “normal range” for neurotransmitters like we do for cholesterol. The activity of the brain is too dynamic to make this kind of simple number test easy to obtain. Gaining neurological fluid samples would be highly intrusive and more traumatic than the information would be beneficial. Brain scans are not currently cost-effective for this kind of medical screening and cannot yet give us the neurotransmitter differentiation we would need.

For these reasons, the diagnosis for whether a mental illness has a biological cause is currently a diagnosis-by-elimination in most cases. However, an important part of your church member’s initial assessment should be a visit to his primary care physician. Encourage your church member to:

  • Clearly describe the struggles/symptoms he is experiencing.
  • Describe when each struggle/symptom began.
  • Describe the current severity of each struggle/symptom and how it developed.

As the person prepares for this medical visit, it would be important for him to also consider:

  • What important life events, transitions, or stressors occurred around the time his struggle began?
  • What is the level of life-interference he is experiencing as a result of his struggle?
  • What lifestyle or relational changes would significantly impact the struggle that he’s facing?

Step 2: Make needed nonmedical changes

Medication will never make us healthier than our current choices allow. Our lifestyle is the “ceiling” for our mental health; we will never be sustainably happier than our beliefs and choices allow. Medication can correct some biological causes and diminish the impact of environmental causes to our struggles. But medication cannot raise one’s mental health potential above what that person’s lifestyle allows.

Too often people want medication to make over their unhealthy life choices in the same way they expect a multivitamin to transform an unhealthy diet. They assume that the first step toward feeling better is receiving a diagnosis and prescription. This may be the case, and there is no shame if it is, but it need not be the guiding assumption.

Encourage your church member to look at the lifestyle, beliefs, and relational changes that his assessment in step 1 would require. If there are choices he could make to reduce the intensity of his struggle, is he willing to make them? Undoubtedly these changes will be hard, or he would have already done so. But let him know that they are essential if he wants to use medication wisely.

As your church member identifies these changes, he should assess the areas of sleep, diet, and exercise. Sleep is vital to the replenishing of the brain. Diet is the beginning of brain chemistry—our body can create neurotransmitters only from the nutrition we provide it. Exercise, particularly cardiovascular, has many benefits for countering the biological stress response (a primary contributor to poor mental health). The first “prescription” should be eight hours of sleep, a balanced diet high in antioxidants, and cardiovascular exercise for at least thirty minutes three days a week.

A key indicator of whether your church member is using psychotropic medication wisely is whether he is using medication (a) as a tool to assist him in making needed lifestyle and relational changes, or (b) as an alternative to having to make these changes. Option A is wise. Option B results in overmedication or feeling like “medication didn’t work either” as he continually tries to compensate medically for the volitional neglect of his mental health.

Step 3: Determine the nonmedicated baseline for mood and life functioning

This is an important, and often neglected, step. Any medication is going to have side effects. The most frequent reason people stop taking psychotropic medications, other than cost, is because of their side effects.

If your church member is not careful, he will merely want to feel better than he does “now.” Initially “now” will be how he feels without medication. Later “now” will be how he feels with medication’s side effects. In order to avoid this unending cycle, there needs to be a baseline of how he feels when he lives optimally off of medication.

One of the reasons postulated for why placebos often have as beneficial an effect as psychotropic medication is the absence of side effects. Those who take a placebo get all the benefits of hope (doing something they expect to improve their life) without any unpleasant side effects. Getting the baseline measurement of how life goes when one simply practices “good mental hygiene” is an important way to account for this effect.

“As I practice medicine these days, my first question when a patient comes with a new problem is not what new disease he has. Now I wonder what side effects he is having and which drug is causing it,” says Charles D. Hodges, MD, in his book Good Mood Bad Mood.

There is another often overlooked benefit of step 3. Frequently people get serious about living more healthily at the same time life has gotten hard enough to begin taking medication. This introduces two interventions (medication and new life practices), maybe three or four (often people also begin counseling or being more open with friends who offer care and support), at the same time. It becomes very difficult to discern which intervention accounts for their improvements.

Writing out his answers to the following questions will help your church member discern if he needs to move on to step 4 and make the needed assessment in step 5.

  • What were the struggles that initially made me think I might benefit from medication?
  • How intense were these struggles, and how did they manifest themselves?
  • What changes did I make in my lifestyle and relationships to alleviate these struggles?
  • How effective was I at being able to make the needed changes?
  • How much relief did the lifestyle and relational changes provide for my struggles?
  • How do I anticipate medication would assist me in being more effective at these changes?

Step 4: Begin a medication trial

If your church member’s struggles persist to a degree that is impairing his day-to-day functioning, then you should encourage him to seek out a psychiatrist or other physician for advisement about medical options. In this conversation, he should consider asking the physician the following questions:

  • What are the different medication options available for the struggle I’m facing?
  • What does each medication do that impacts this struggle?
  • What are the most common side effects for each medication?
  • How long does it take this medication before it is in full effect?
  • If I choose to come off this medication, what is the process for doing so?
  • What have been the most common affirmations and complaints of other patients on this medication?

These questions should help him work with his doctor to determine which medication would be best for him. Remind your church member that he has a voice in this process and should seek to be an informed consumer with his medical treatment, in the same way he would for any other product or service.

In this consultation your church member will also want to decide upon the initial period of time to remain on the medication (unless he experiences a significant side effect from it). In determining this length of time, he would want to consider:

  • His physician or psychiatrist will make recommendations based upon additional factors (beyond the scope of this article)
  • Staying on the medication a minimum of at least twice the length of time it takes to reach its full effect
  • Significant life stressors that would predictably arise during this trial period (e.g., planning a wedding)
  • How long it would take to make and solidify changes that were difficult to make without medication (see step 3)

Once this set period of time is determined, your church member’s goal is to continue implementing the changes he began in step 3 while monitoring (a) the level of progress in his area of struggle and (b) any side effects from the medication.

Step 5: Assess level of progress against medication side effects

Near the end of the trial period, your church member should return to the life assessment questions he answered at the end of step 3. He should compare his ability to enjoy and engage life at this point with his answers then. The questions to ask are:

  • What benefits have I seen while on medication?
  • What side effects have I experienced?
  • Is there reason to believe my continued improvement is contingent upon my continued use of medication?
  • Are the side effects of medication worth the benefit it provides?

The more specific he was in his answers at the end of step 3, the easier it will be for him to evaluate his experience at the end of step 5. At this point, encourage him to try to be neither pro-medication nor anti-medication. His goal is to live as full and enjoyable a life as possible. It is neither better nor worse if medication is part of that optimal life.

Step 6: Determine whether to remain on medication

At this point in the process there are several options available to the individual; this is more than a yes/no decision. But any option should be decided in consultation with the prescribing physician or psychiatrist. Your church member can decide to:

  • Remain on medication because the effects are beneficial and the side effects are minimal or worth it.
  • Opt to stage off the medication because the benefits were minimal or the side effects were worse than the benefits.
  • Stage off the medication to see if the progress he made can be maintained without medication, knowing that if not, he is free to resume the medication without any sense of failure.
  • Opt to try a different medication for another set period of time based on what he learned from the initial experience.

Regardless of what he chooses, by following this process he can have the assurance that he is making an informed decision about what is the best choice for him.

Q&A: He’s Sorry Now. Do I Wait?

SOURCE: Taken from an article by Leslie Vernick

Question:  My husband has had several affairs. One sexual and the others emotional. After each one I have tried to work on me and felt they occurred because I needed to fix things in my own life. I needed to be more loveable, appealing and easy to be with. In so many ways I have been completely humbled and broken, but despite the changes in my own life I recently discovered he had resumed calling the woman he had been having an emotional affair with 4 years ago. In addition, he has confessed to having a sexual addiction or integrity issues involving pornography and pleasing himself sexually. Yet, even while he has been doing this, I have felt loved and cared for by him most of the time.

My biggest concern has been however, when we have discussions, I feel very intimidated by him and end up backing away or apologizing profusely because I’m afraid of his anger and intimidation. I’m not perfect and see so many of my own faults and insecurities but I desire to have intimacy with God.  I’m fit, I have a great profession, close relationships and work at being a good parent to my son (16) and daughter (18).

So here is my dilemma. My husband and I are separated. After the last affair, it was agreed if he ever did this again it would mean automatic divorce, no more counseling, etc. When we first separated I felt scared, but now after 5 months I’m fine and our children are fine.  They say they prefer him gone and we have needed time to heal. Before, I tried so hard to rebuild my marriage that our children took a back seat. Now I’m enjoying the peace of our home instead of always being anxious that I would make a mistake that would drive him into the arms of another woman.

I’m thriving, going to a great Christian counselor and reading and trying to understand sexual addiction. However, my husband wants another chance and feels he now understands why he made so many hurtful choices. He periodically meets with a pastor from our church but has not sought counseling or a recovery group. He seems softer, has realized much and constantly says he misses me and loves me, but I have lost my desire for him. I almost would be embarrassed to put myself through this again but feel guilty or unsure if I’m disobeying God. Isn’t God a God of second or fifth chances?

I have never been good at discerning when my husband was betraying me how can I ever trust him. How do I know if he is fully recovered? Am I being disobedient by not giving him another chance?

Answer: Oh how we wish life’s decisions could be black and white and that God would just tell us what to do. I struggle with the same dilemma of “not knowing” the future, or the reliability of a person’s words.  Talk is cheap and insight, even good and truthful self-awareness, is still a long way off from faithful and consistent change in a person’s heart and habits.

The good news is you don’t have to decide just yet about whether or not to follow through with divorce. Although you certainly have biblical grounds. You indicate you are getting good counsel so I’m going to give you some things to talk about with your counselor to make sure you are moving in the right direction.

First, pay attention to your feelings but don’t allow yourself to be ruled by them. You feel anxious about his anger and intimidation. Is this true in other relationships or mainly with him?  You indicate your own insecurity issues and sometimes people who fear rejection are easily intimidated into compliance because they fear disapproval or loss of relationship even when the other person isn’t intentionally trying to be controlling.

This season of separation can be a good test for you to observe the fruit of your change as well as his.  Are you able to speak up and say no, even if you still feel anxious or intimidated? And, can he hear and respect your “no” the first time, without arguing, trying to change your mind or threatening you with loss of potential reconciliation? If you’re still not able to be clear and direct with what you want or don’t want because of fear, you need to figure out why.  Is it him or it is your need to please, to not disappoint, to be a good Christian girl, and/or to always be the accommodating one?

Your husband has done great damage to your family and marriage yet he doesn’t seem to be working very hard to make sure he never does it again. That does not sit well with me at all. Why has he not gone to personal counseling, joined a recovery group or taken other steps to deal with his problems? You say you’re reading about sexual addiction, but is he? You seem to have done lots of work to mature, grow, and become a more godly woman but what exactly has your husband done to identify his problems and change them?

From what you describe, it seems to me that your husband has been ruled by a selfish and a lazy heart. (These are defined more fully in my book, The Emotionally Destructive Relationship). Pornography is a selfish and lazy way to have sexual pleasure and release without the responsibilities of relationship or mutual giving. It’s all about him!  From what you describe, most of the marriage has been all about him and what you’ve lacked or not done to make him happy or keep him faithful to you.

Affairs are also selfish and indulgent. He wasn’t thinking of you or your children, only about what he felt and what he wanted. From my vantage point what you describe as your husband’s change is really just more of the same but now instead of the other woman, you’ve become the desired object he wants.

Yes, God is a God of second chances, of fifth chances, of hundredth chances, but you are not God. You do not know his heart.  Only God can discern his true motives. However, you can use the growth you’ve achieved to speak the truth in love, ask him to do the work required in order for you to be willing to consider reconciliation and build trust again and see what happens. If his heart is truly changed, he will. If not, he will get angry, blame you and want you to do the work to trust him. You’ve already been around that bend several times and you’re wise to not repeat it.

Denial or Overreaction: Where’s the Balance?

SOURCE:  Karl Benzio/Lighthouse Ministry Network/Stepping Stones

Don’t Wait … Do It Now!

When faced with difficulties, the discomforts that comes from daily storms, or life’s challenges, our natural reactions, without any thinking, usually fall into one of these two ‘Fight or Flight’ categories: 1. Ignore or run away from the problem and hope it goes away, or 2. React in a knee-jerk way to the problem.

While this second response usually brings immediate relief, it often guarantees more damage later on. Obviously, neither option works well for long-term fulfillment or peace. But we’re all addicted to comfort … we all turn to idols of the heart instead of turning to God. So, like a gunslinger from the Old West, we continue to quick-draw these so-called defense “weapons” when we feel threatened by the adversity God allowed to enter our day.

I have learned … well no, I actually continue to learn, and sometimes the hard way, that failing to deal with adversity immediately compounds the pain and suffering. Waiting, ignoring, or hiding never makes it better. But even though I know that I shouldn’t put it off, reacting on the spot with my not-thought-out knee-jerk response is going to lead to a lot of damage as well. I have to think first and then respond to have the best chance for success, especially in challenging situations that press my emotional buttons.

Using either the “ignore it” or “react without thinking” strategy really shows a “my kingdom come, my will be done mentality.” It exposes our lack of faith in God’s promises, track record, character, sovereignty and plan for our lives. We really need a “Thy kingdom come, Thy will be done” mindset. That perspective recognizes His majesty as well as our limitations. It also helps us develop an optimum plan to attack the challenge before us.

[In scripture], Jesus Christ lays down a very important principle: do what you must do now. Do it quickly. If you do not act immediately, if you do not pay the price to settle the adversity, an inevitable process will begin. And that process will not stop until you have “paid the last penny.”

Think of an adversity that continues to drain you. Why do you fail to address it head-on with Godly discernment? Settle that score today within the limits you can control. God has given you answers to deal with it externally (your outward behavior), and internally (inside your head and attitude). Don’t procrastinate. Act now to move toward the mind of Christ, because that is where you will find God’s peace. Whether you act clearly and immediately when confronted by a challenge or you procrastinate is your decision, so choose well.

Dear Father God, I know I have stayed away from Your light out of fear that my bad deeds, sins, and adversities will be exposed. I no longer want to live in darkness. I pray, Father, that You will help me live by Your Truth and in Your Light so that all can see what I do is done through You. Help me, Lord, to learn to deal with my adversities immediately so that they won’t fester and grow. But help me see life through Your eyes then respond with Your wisdom. I pray in the name of the One you sent to teach us truth, Jesus Christ – AMEN!

The Truth
Settle matters quickly with your adversary who is taking you to court. Do it while you are still with him on the way, or he may hand you over to the judge, and the judge may hand you over to the officer, and you may be thrown into prison. I tell you the truth; you will not get out until you have paid the last penny. Matthew 5:25,26

This is the verdict: Light has come into the world, but men loved darkness instead of light because their deeds were evil. Everyone who does evil hates the light, and will not come into the light for fear that his deeds will be exposed. But whoever lives by the truth comes into the light, so that it may be seen plainly that what he has done has been done through God.  John 3:19-21

Ending Toxic Relationships: Am I being a poor example of Christ to others by my decision?

SOURCE:  Leslie Vernick

Topic: Am I Being a Bad Example?

This week’s question: I separated from my husband after 25 years. I can remember being pregnant with my now 22 year old son feeling distraught and asking myself why I am having this man’s baby?

The emotional destruction took place throughout 22 years of the marriage. I have asked numerous times to go for counseling and actually moved out twice only to come back to empty promises of change from him.

I feel a sense of peace in every cell of my body that I have not felt in decades. My concern is am I honoring God with my decision for self-preservation, my sanity? 

Am I being a poor example of Christ to others by my decision?

Answer: Your question captures the dilemma so many women who are in an emotionally abusive/destructive marriage experience once they prioritize their sanity and safety over keeping the marriage together. They fear God’s anger and his disappointment. They fear being a poor representative of Christ and feel guilty when they finally say “I can’t do this anymore.”

I deeply appreciate that you don’t take your marriage vows lightly. We ought to press pause for self examination, prayer, and Biblical counsel if ever we consider separating from our spouse, so that if we separate, we are separating for biblical reasons and have as clear a conscious as possible.

Let me encourage you that God values physical safety and relational safety as much if not more than you do. For example, in spite of God’s general instructions to submit to the laws of the land and to higher authorities, when David feared for his life because of King Saul’s jealous rages, God didn’t instruct David to “submit to the King and trust me to take care of you” Instead, David fled, always respecting the position of King Saul, but not allowing himself to be abused by him. (Read 1Samuel 18-31 for the story.)

In another example, when Jesus was born and King Herod sought to exterminate all the Jewish babies two years and younger, God told Joseph in a dream to flee to Egypt until it was safe to return (Matthew 2:13-15).

When Rehab hid the Jewish spies, she lied to keep them safe and God commended her (Hebrews 11:31). I suspect those who lied to keep Jews safe from the Nazi army were equally commended by God.

Jesus himself valued safety and said even the well-being of an ox was a higher value to God than legalistically keeping the Sabbath by not working (Luke 14:5).

Safety is an important component of trust especially in marriage. There can be no freedom or honest communication if someone feels afraid or is threatened, either physically and/or emotionally or has a price to pay whenever they honestly share their thoughts and feelings.

Women (and sometimes men) fear taking measures to protect themselves because they’ve been taught it’s unbiblical or ungodly. They suffer endlessly with verbal battering, even physical abuse believing that by doing so, they’re being godly martyr’s. Keeping the family together at all costs is seen as God’s highest value.

Yet Proverbs 27:12 teaches us, “The prudent see danger and take refuge.”

Sanity is also an important value to God. By sanity I don’t just mean good mental health from a secular point of view, but good mental health from God’s point of view. Again the writer of Proverbs warns us of the devastating consequences of living with a contentious and argumentative person (Proverbs 15:4; 17:1; 25:24; 26:28).

The scriptures are clear. People influence and impact us, both for good and for evil. When we live with an abusive, destructive, manipulative, deceitful person, it definitely takes its toll on our mental, spiritual, emotional, physical and spiritual health.

Being sane from God’s perspective involves knowing, believing, and walking in the truth. Jesus says, “If your eye is good, your whole body is filled with light. But when your eye is bad, your whole body is filled with darkness. And if the light you think you have is actually darkness, how deep that darkness is (Matthew 6:33). The apostle Paul says by nature we exchange the truth of God for a lie and that the more we do that, we become more and more insane (depraved mind) (Romans 1:25-28).

Walking in the light and truth are important values of God. When you live with someone who prefers deceit and darkness and twists and manipulates the truth, it can be very stressful.

However your question is, Are you being a poor example of Christ to others by leaving? My answer is maybe. You also could be a poor example of Christ by staying. You see it’s not whether you leave or stay that determines whether you are letting the love of Christ rule you, but how you leave or how you stay.

There are people who choose to stay in a destructive marriage (for lots of reasons) and are terrible examples of Christ. They are bitter, angry, spiteful, depressed, resentful, and demonstrate no joy, peace, or hope in their countenance. Likewise, those who leave a bad marriage can also leave with those same negative emotions in control rather than Christ.

So what would it look like to be Christ-like and God-honoring even while leaving a destructive marriage?

Here are a few thoughts for you to ponder. The apostle Paul says that we’re not to only look out for our own interests, but also to look out for the interests of others (Philippians 2:4). You are looking out for your interests for safety and sanity by leaving. That’s not ungodly or sinful. But if you want to be a godly wife, you must also look out for your husband’s interests. So what is your husband’s greatest need right now? Is it to stay with him, make his dinner, be his companion, and meet his sexual needs or is it something far more crucial to his long-term well-being? I believe your husband’s greatest need right now is to wake up from his slumber, from his darkness and to come to Christ and repent of his destructive behaviors. The question you must answer is would you more likely help meet his greatest need by leaving or by staying?

Second, God calls you to love your husband, even if he feels like your enemy right now. That is being Christ-like. However, you must also understand that unconditional love doesn’t entitle someone to unconditional relationship even with Jesus. The scriptures tell us that our sin separates us from close relationship from God. It doesn’t separate us from his love as Paul tells us that nothing can separate us from God’s love (Romans 8:38,39), but it does separate us from his Presence.

If Jesus doesn’t offer unconditional relationship with everyone even when he loves them, I don’t think he expects that of us either. Sin not only separates us from God, it separates us from one another. Until your husband can see his sinful heart and actions as damaging not only you, but your marriage and is willing to actually do the work it takes to change them, it may be most Christ-like to stay compassionate toward him yet separate from him.

One more thing. For your own peace of mind, please ask God to show you how to represent him well in this time. You must let go of your desire for everyone to agree with your decision to separate. You may be Christ-like in all your actions and attitudes and people still may not like it. Jesus represented the character of God perfectly and yet there were those, especially religious leaders, who did not approve.

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