Mental Health Awareness Month: Catherine’s story

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For Mental Health Awareness Month, I have decided to bring you stories of Christians who struggle with mental illness. This story, written by “Catherine” herself, describes the struggle that is very common among Christians about whether or not to take medication for depression or other mental illnesses. This is an excerpt from my book, On Edge: Mental Illness in the Christian Context. You can buy my book as well as a Leader’s Guide that goes with On Edge to help you lead a small group at your church about mental illness.

Case Example

Catherine had struggled with anxiety for a long time.  She wasn’t sure what tipped her into depression, but it seemed like a combination of causes: she had been in a five-year relationship that she thought would lead to marriage, but instead it ended.  One and a half years later, she hadn’t met anyone else, and her hopes for getting married in the future were dwindling.  Work was also very stressful and felt out of control.  Catherine’s sense of worth and being able to handle things started to shoot down.

Catherine began to use eating and food as a way to feel in control again.  Without even realizing it, she began to develop an eating disorder as she carefully calculated what she would eat.  Catherine felt like she was accomplishing something when she ate less and less and convinced herself that she didn’t need food.  Within a few months, she had become very self-focused. Catherine felt restless, slept little, and generally felt “sick”—like she had a “flu” of sadness, anxiety, hopelessness, and a loss of joy.  She remembers thinking that maybe it wouldn’t be so bad if she died.  Crossing the street became an opportunity to see if maybe a car would hit her and she wouldn’t have to struggle like this anymore.

Catherine had no idea she was dealing with depression, because she had never had a depressive episode before.  Her friends and family knew her as a very happy, friendly person—that’s how she had been all her life.  Now they (and she) saw someone completely different.  People expressed worry and concern about her.

Catherine was already in therapy with a professional Christian counselor.  Her counselor brought up the possibility of talking to her doctor about trying an anti-depressant.  “Me?” Catherine thought.  “I shouldn’t have to go on medication for depression.  Other people do that, but not me.” She wasn’t ready to seriously consider it.

But as a few months passed, Catherine’s depression felt worse and deeper.  She was also losing a lot of weight.  She agreed to make an appointment with her doctor, who expressed concern.  Catherine’s doctor told her that she prescribed anti-depressants for a lot of her patients, who need them for a time, and can then go off the medication.  As her doctor normalized the idea a bit, it took away some of the shame for Catherine, the feeling that “I shouldn’t need medication for this.” Catherine’s doctor also told her that she might not need to take the medication forever.  If she decided to take it, her doctor would start her off on a small dosage, and monitor her to see whether the dose needed to be increased.  If it didn’t work, she could try a different medication.  If it did work, Catherine would start to feel more like herself again.  Her doctor told Catherine that this wasn’t a “happy pill,” but that if it worked for her, she might smile or laugh a little more.  She’d feel more like herself again.

Catherine’s doctor gave her the prescription, and Catherine held onto it for awhile. Catherine still wasn’t ready to try this route.  She thought maybe she could get better without it.  Besides, maybe she was supposed to struggle through this “depressive episode,” and God would bring her out of it when He was ready.  Medicating herself for depression seemed like a thing that privileged, over-worked, over-stressed Westerners did.  If she just depended more on God, He’d bring her out of this when He was ready to. Catherine didn’t need to “fix it” with a pill.  That seemed like the easy way out.

Catherine’s mother also told her that she worried that if Catherine started taking medication, it might make her feel better, and then she’d never do the work of figuring out the underlying causes that led to her depression in the first place.  Her mother also worried about when Catherine would stop taking the meds; she’d heard stories about people becoming suicidal if they stopped taking anti-depressants too quickly.  (Catherine didn’t want to scare her mother, so she didn’t tell her that she was already having semi-suicidal thoughts!)

Catherine’s counselor encouraged her by telling her that she would most likely be starting on a very small dose.  She told Catherine that she probably wouldn’t feel any different until her doctor gradually increased the dosage.  So Catherine started taking Celexa.  Her doctor gradually increased the dosage.  She had to increase it very slowly, as at first Catherine felt a little dizzy and lightheaded from taking the pill.  It also made her feel more awake when she took it at night, as her doctor had recommended, so instead she started taking it in the morning.  Catherine didn’t feel any different for the first two or three months of taking the medication.

Catherine remembers the day when she realized she was feeling more like herself again.  She was standing in front of her bathroom mirror, putting on makeup and thinking about the day ahead.  Her friends were getting together.  For the past few months she had been avoiding them, just wanting to isolate herself and be alone. Catherine had had no social energy.  But now, she realized that she actually wanted to be with her girlfriends that night.  That felt more like the person she was before depression.

From then on, Catherine’s symptoms did not totally go away.  But she felt thankful that she had started taking Celexa, because whatever it did in her brain enabled her to function at a level at which she had been unable in her depressed state.  She had more energy and mental clarity to deal with her sense of hopelessness about the future, and the way she was striving for perfection at work.  With the encouragement of her counselor and her family, Catherine found a very kind nutritionist who was very familiar with eating disorders.  With the nutritionist, Catherine developed a healthier eating plan, and she helped Catherine to realize why she was striving for “thin-ness.”  It really was about control and a sense of wanting to achieve something…but in the process, Catherine was destroying her body.  With the nutritionist’s help and a lot of prayer from her family and friends, Catherine gradually started to gain back the weight she had lost, and also started forming healthier attitudes about food and exercise.

In the following months, as Catherine continued taking Celexa, going to therapy, and seeing her nutritionist, she started to get better.  A little less than one year after she started taking the medication, Catherine’s doctor and counselor thought she was ready to start tapering off.  At first she did so too quickly, and randomly had very dark thoughts run through her mind, ones that reminded her of when she was depressed.  She called her doctor, who helped develop a very slow tapering-off plan, because Catherine’s body was proving to be very sensitive to the change in dosage.  Over many months, she gradually tapered off the Celexa, and eventually stopped taking it altogether.

Catherine is really thankful for the encouragement of her therapist and doctor to start taking an antidepressant.  Would God have brought her out of depression if she hadn’t taken the medication? Maybe.  But it also scares her to think of what she could have done to herself if she had stayed in that depression for much longer.  She was already starving herself, and her body was suffering.  She still feels guilty sometimes for “giving in” and taking an antidepressant.  But she does think that God used it to help her heal, and she’s really grateful for that.  In the future, if she starts developing signs of depression again, Catherine thinks she would be open to taking the medication again.

Counselor’s Response

Catherine’s story is similar the experiences of many in the church. For a variety of reasons, symptoms of mental illness become present and require treatment, including medication in some cases. For many who have not had mental health treatment before, the idea of taking medication for emotional symptoms seems foreign, scary, or even morally wrong.

Medication is not necessary in all cases. For many, simply talking about their problems and developing new coping skills and new ways of thinking is enough. For many others, these strategies help a little, but the physical and mental symptoms are too intense or persist for too long to go away without medical intervention.

Before you take any medication, you should talk with your doctor about your options. Catherine found that Celexa worked well for her, others may find that another medication targets their symptoms better. Your doctor or psychiatrist can help you determine what medication may be right for you, and they can evaluate whether or not you truly need medication. A professional Christian counselor is often a good first step, as he or she will be able to help you with coping and other strategies to try before deciding to ask your doctor about medication. Unless you are having thoughts of hurting yourself or someone else or are hearing or seeing things that others do not, you may want to try things like exercise, writing in a journal, or muscle relaxation first. If these behavioral strategies do not work effectively to reduce your symptoms, medication may be necessary.

Many people have asked, “Isn’t taking medication just the easy way out?” Some fear that taking medication is an excuse not to work through their problems, or they view it as an admission that they do not trust God. These views of medication give it a much higher power than it actually has. Medication will not take away your problems. It is not in opposition to God, and many have to trust God more in the process of trying medication that they feel nervous about taking. No medication will take away all of your symptoms, and you should not feel “drugged” or “out of it” when your symptoms are properly treated.

Medication is simply a tool. It is one piece of the treatment puzzle that actually works best when combined with counseling, as numerous studies have shown. When your emotional symptoms are treated, you are able to think and feel more like yourself again. You will continue to have problems, but you will likely find that you have more energy to actually face them and make some changes in your life. You may find that you are able to enjoy life again, and this may actually help you to relate to God better.

As with any medication for any illness, there is the potential for side effects or reactions. Not every medication works for everyone, and unfortunately sometimes there is a trial-and-error process in finding the right one for you. As medical advances progress, perhaps we will develop more accurate ways to test for specific mental illnesses and be able to know in advance which medications will work best to target each specific brain dysfunction. For now, hang in there. Medication is not the answer to all of your issues, but it is worth trying when you and your doctor feel that the risk of not treating your symptoms outweighs the risks of taking medication.

Untreated symptoms of anxiety, depression, or other disorders can be fatal (see chapter 14 for a discussion on suicide). Some studies have also found links between untreated depression and other diseases such as heart disease, diabetes, Alzheimer’s. If you feel that your symptoms are getting worse or are not helped by some simple lifestyle changes (such as diet and exercise), you may be putting other aspects of your health at risk.

Jesus came to earth as a healer, and when we take steps towards health we are participating in the restoration of our bodies. In our modern era and society, some of the tools that bring about healing are medicine, surgery, and physical therapies. As Christians, we trust and believe in God for healing, not by rejecting the medical treatments available to us, but by recognizing that it is always God’s power at work that brings healing. He can and does heal in miraculous ways and through modern medical technologies. We do not make medicine our god, but we thankfully receive all that God has given us to promote life and wellness. Whether we suffer from diabetes, cancer, depression, or schizophrenia, we can experience recovery and wholeness by seeking God and seeking any treatment available to us.”