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Taking Some Pills, Changing Our Thoughts, or Purifying Our Heart

May 24, 2013

In life, there are certain inner difficulties that spawn a host of enduring, dysfunctional patterns causing continual distress and constituting new, serious problems in their own right. And although the Christian faith advises looking within to the thoughts of the heart, we often shift our focus from the inner difficulty to the warning signals of distress and naively suppose that if we take care of the distress by external means such as taking the right kind of medication, things are as they should be. In fact, we are simply becoming dependent on other external supports without any deeper healing taking place. God “desires that we be delivered from the bondage” of depression and anxiety “into the glorious liberty of the children of God,” becoming vessels of love, bearers of peace, instruments of His own compassion for creation. Unfortunately modern society encourages us to set our sights far too low.

The following excerpt from The Guardian, a newspaper in London can help put a human face on what I am talking about:

Ever since she can remember, 21-year-old Emma Campbell has been living in a state of heightened anxiety. As a child she used to stay up worrying about school work and her family, becoming so anxious that, eventually, she stopped eating. She was seven when she first started suffering panic attacks, waking up out of breath and sweating almost every night for several years.

Campbell received therapy as a teenager, which offered her some respite. But panic set in once again when she left her home in North Yorkshire to attend university in Wales, where she is currently studying psychology. Although she is now taking antidepressants, which are often prescribed to treat anxiety, she says she still finds herself “on edge” most days. “I worry if I’m a good person. I worry about the future. Yesterday, I had a panic attack because I’d progressively convinced myself that this chesty cough I’ve got is lung cancer. I know deep down it’s just a cough, but something takes over me and tells me everything is a thousand times worse than it really is.”

How many people have had similar distressing experiences with generalized anxiety, a state of foreboding, and dread about the future that takes over and controls patterns of thought, behavior, and social interactions. The paper notes that Emma has been treated with anti-depressants, yet some mental health professionals are questioning the effectiveness and wisdom of a pharmaceutical treatment option instead of cognitive behavior therapy. The Guardian author writes, “Mental health charities say they are concerned antidepressants are too often used as the first point of call to treat anxiety, when cognitive behavioural therapy (CBT) could prove more beneficial. Paul Jenkins, chief executive of the charity Rethink Mental Illness, says that in some cases people are ‘fobbed off’ with medication alone: ‘No one should have to take any kind of medication unless it’s absolutely necessary, and talking therapies have been shown to be just as effective as drugs for moderate to severe anxiety, so patients should be given a choice at the very least.’

In my previous blog post on suicide, I pointed out the integral role played by certain kinds of negative thoughts, the same holds true for generalized anxiety with thoughts of worry. The interpretation we give to our situation or our physical responses is intimately related to anxiety. Of course, we can try to change our physical responses or modify our situation, but the only approach that can really bolster human freedom is to be able to change our way of interpreting our world. This is in keeping with the fundamental teaching of Christianity that it all begins in the disposition of the heart. The most beneficial treatment that expands our real choice is an examination of problematic thoughts and an exploration of methods to cope with them.  Often, pharmaceutical treatment options merely mask the underlying causes of anxiety disorder and only temporarily affect one’s emotions. Just as the problem of suicide is not primarily about friends and money, but about our way of looking at the world, so the problem of anxiety is not primarily about medications, but again how we interpret the world around us.

Cognitive therapy may play a crucial role in helping the anxiety sufferer re-focus attention on the present without the indeterminate speculation on the future.  The ancient fathers recognized the dangers of future oriented thinking and their relation to anxiety and fear. Of course, symptom reduction is good, but ultimately not good enough. Mood disorders are more than just unpleasant emotions sabotaging life’s activities. Such conditions are about a restricted freedom that does not allow people to do all that they are called to do. Medicines have their use, but the only way to outward freedom is to acquire inner freedom. And the path to inner freedom is to learn how to respond to the thoughts, when to respond to the thoughts, how to judge the thoughts, how to act in spite of the thoughts, and above all, how to cultivate thoughts that bring peace, hope, and love. Cognitive therapy can guide someone to initial steps to adaptive functioning; the Church fathers can point out the signposts that lead beyond that adaptive functioning to that way of life, which is eternal.

In an earlier blog post, I mentioned, “I’ve written concerning the psychological and spiritual harm caused by focusing on the future without due regard for the present. Those comments still apply today: “We all have a spiritual heart that we can strive to discover through simple repentance and by calling upon the name of our Lord. It will take time for our fears, anxieties, and imaginings to weaken. Remembering God, remaining in the present, vigilantly guarding the heart against the ‘terrors of the night’ by trust in God will help.  Love, we are reminded in Scripture, casts out all fear. Love that is not selfish, but given wholly over to God, does not have the mental space to give itself over to fear.  As I mentioned in a previous blog post, “So too, in our own lives, Jesus is not to be found in death (fear).  “He is not here.”  He has overcome death and cast out all fear, trampling down death by death.  Whatever we fear, whomever we fear has been conquered by the glory of the Cross and Resurrection.  If we have fear ever dwelling in our hearts, we are harming our physical, mental, and spiritual health. Neuroscience, psychiatry, and the Gospel agree on this point. Such fear is certainly not of God. Such fear keeps us chained to illusory and deceptive thoughts that alienate us from God and one another.  Yet, that chain has been broken, Satan has been conquered, fear has been overcome.  We need only recognize this and be glad in Him who has made us a new creation.”

  1. elijahmaria permalink

    I spent nearly 35 years hiding chronic panic and anxiety, till finally I could not take a shower in peace, nor could I leave my house without having a good friend with me: someone who knew me well enough to know my ‘secret’ and well enough not to pressure me about anything. I had those kinds of friends in those days, thank God. I hid the condition, because when I first described the symptoms to my family doctor in my early twenties, he told me that if I did not get myself together I’d be facing a life of drugs and electo-shock therapy. Period: end of visit. I told no one what was happening to me for another 20 years. Now, another 20 years later, I am still drug free. I’ve had the same spiritual father for nearly 17 years. I am a work in progress of course but I do what I am able to do to encourage friends and family in their own struggles. I live the life of a penitential solitary and take care of an aging mother, who still toddles around on her own steam at 82. Your book is on its way to me, sent by a dear friend, and I look forward to reading it and comparing notes. …..M.

    • M.,

      I hope the book and the blog will provide you with some additional direction in collaboration with your spiritual father. Although sometimes medication is quite necessary, it is good when one is able to find healing in other ways. Our Lord teaches, “In you patience, possess your souls.” And 20 years is a mark of patience, too quickly reaching for pills certainly is not.

      Fr. Alexis

      • elijahmaria permalink

        Dear Father Alexis: To be fair, I have had some help in buying that time. Due to the severity and longevity and most likely source of the chronic panic, I was able to eventually qualify for disability assistance about 12 years ago, and so was able to take the time necessary to slowly come up out of the mire, out of the pit, so that I could indeed stand upon the rock. There’s a whole set of stories, useful ones I think, that go along with all this that I may or may not tell some day. But the simple truth is that God has taken care of me throughout, even though I seemed to turn my back on Him.

        One of the things that I would like to discuss more with you privately, if that is possible, is that whole process of story-telling and talking about the spiritual life when I have actually chosen a path that is more hidden. That and my responses to your book as I read and reflect. Is it possible to speak to you outside of the blog?….Mary

    • There is a mental health group called GROW. Get Rid Of Worry. It was founded by an Australian priest who suffered from a nervous breakdown. They have weekly meetings as AA do. People are helped in these groups. They are worth investigating.

  2. Fr. Alexis,

    Does glossophobia, or the fear of public speaking, fall under the categories of fear and anxiety written about in this post? Is the fear of public speaking something that God wants to set us free from? Sometimes I think that it could never be, brushing my fear of public speaking under the rug, thinking that it is not a fear worthy of God’s attention. But I’m sure there is more to it than simply “being afraid of getting up in front of people and speaking.” I’m sure there’s a deeper issue with it, no?

  3. TJ,

    Fear of public speaking is a phobia that I have more than a theoretical knowledge of. Some years back, I would have such a reaction when called upon to give extemporaneous homilies in Greek, which is not my mother tongue. In my case, I certainly felt that it was something that God wanted me to be set free from. I was aware of psycholtherapeutic approaches, but what helped me the most before speaking was to queitly say a sincere prayer asking God to grant me words to speak through the prayers of Saint Demetrios (the patron of the monastery where I now serve) and to look at the listeners as beloved children of God whom I love as well. Is there something deeper? Well, in my case, I can see that there was a need for greater faith, that God could use me despite my weakenesses and imperfections as well as a need for a greater degree of loving kindness towards those to whom I was speaking. The physiological reactions of a heightened heartrate may still come from time to time, but that too is okay, once the thoughts are put in order. So in short, yes, the fear of public speaking is worthy of God’s attention as is anything that can hinder us from possibily fulfilling his commandment of love of neighbor. I hope this helps.

    Fr. Alexis

  4. Mary,

    Telling one’s story can be helpful and healing, especially when we make God the central character. That could be a very good thing to do with your spiritual father.

    In terms of speaking or corresponding about personal issues outside of the blog, there is certainly a part of me that would very much like to say yes to everyone, but in addition to the limits of time, as a monk, I need to balance the time that I devote to prayer, study, and the liturgical services as well as the time in outreach through tending to the needs of spiritual children and the efforts to keep up this blog. I am sorrry to disappoint you, but perhaps even responding to posts that touch on your own issues, you may find further guidance and provide further guidance to others.

    Fr. Alexis

    • elijahmaria permalink

      My spiritual father is more than happy to have me begin to do more, almost eager. His monastic training is among the Benedictines where the active life is taken as part of the way, more than say the Carthusians or Carmelites, or some Orthodox houses. So I was looking for a response from those whose lives are more hidden. At any rate, I expect there will be help and clarity. when the time comes.

      I should have known and not asked, Father. Thanks for being gracious.


  5. mary benton permalink

    Fr. Alexis –

    Thank you for this lovely blog post. I fully agree with you that medication is too often the first line of treatment for anxiety when it need not always be. (Sometimes it may need to be if the anxiety is extreme, I think.) What is truly concerning is that so often medication is used as the ONLY line of treatment, given by a primary care doctor, and nothing more is done to educate the individual about anxiety and its possible treatments.

    I have the perspective of having been a patient with anxiety and being a psychologist that treats anxiety (both for quite a long time) :-). I believe that cognitive-behavioral therapy, spiritual deepening and medication can often combine well for those with more persistent anxiety problems. I do believe there are genetic and biochemical factors for some people. Though I will never like having anxiety, I now am able to see my past experiences with it as a blessing that has enabled me to guide and walk with others through their terrors.

    I know that you are not saying this, but sometimes I feel concerned that anxious people may get the impression that they experience anxiety because they are not loving God or believing enough in Him. This gives rise to dysfunctional thoughts and perfectionistic self-criticisms that generate more distress for the sensitive soul. (“I shouldn’t feel anxiety. Christ has conquered fear and death. What’s wrong with me?” etc.) My priest has said that anxiety is a mild form of atheism and that disturbs me for the sake of those still vulnerable. (He is a humble enough man to allow me to express a dissenting opinion, however.)

    I would welcome your comments on this, if you care to offer them.

    • Mary,

      Thank you so much for sharing your comments and experience with us on this blog. I can see that suggesting to someone suffering with anxiety that the problem is a lack of love or faith is not going to help, because while it may be true of all of us to varying extents, I do not believe that such are the distinguishing characteristics of someone with anxiety. Rather, the problem seems to me to be a difficulty in being aware of God’s tender love and care for us, when our minds are riveted to a given threat and our bodies automatically react accordingly. That difficulty is normal, not pathological, more psychological than theological. The feared threat, however, may not be so reasonable. It is at this point where cognitive therapy could be useful. It is at this point that faith in God can bolster the therapeutic process, for if it is unreasonable to fear, say, passing out in public with God outside of the equation, it is incomparably more unreasonable when the most important factor in the equation of our life is present. Thanks once more for your comments.

      Fr. Alexis

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