You are not defined by your Mental Health

In all of these situations I remember a deep underlying feeling of compassion.  It can be so easy to only see these people for their mental illness, but this does not make up who they are.

Mental illness is a problem we encounter in the medical field that often comes with a stigma. Patients who are afflicted by a psychiatric problem are often marginalized and not given the time needed to appropriately help them.  In primary care especially, we have a limited time to see a patient, diagnose a problem and treat it.  This leaves little time for the counseling required for patients.  This is simply not right and leaves the patient at a severe disadvantage in progressing towards improvement and freedom from the mental disease. Of all places, a primary care office should be a safe, trusted place to be honest and seek care.

One of the difficulties I face is the outside stigma that depression and anxiety are problems that are simply “in a person’s head” and if they try hard enough they can get themselves out of it.  Often this is not true and the illness requires outside help through counseling and sometimes medication. Sometimes I see this in those of faith because they feel that as a believer in a God who loves them there should be no reason to be depressed.  Because of this they deny the illness and sometimes delay or refuse appropriate treatment. Depression and other mental illnesses, however, have no regard for whether you have faith or not. Mental illness is due to abnormal levels of chemicals in the brain called neurotransmitters and require treatment through counseling and sometimes medication to help stabilize these levels.

A quick note on psychiatric medications.  If your doctor feels that you will benefit from a medication, please consider it and don’t deny it just because it is a psych med.  Everyone who has mental illness should recieve  counseling and in some cases medication is needed. If you desire, it is completely acceptable to ask for a referral to a psychiatrist for an expert opinion on whether you need medication and which one would be most appropriate.



In exam rooms I’ve sat across from those suffering from depression to anxiety; from bipolar disorder to schizophrenia.  I’ve been with those afflicted by a persecutory complex and followed them down the rabbit hole of who was out to get them.  I’ve been in a psych ward at the VA and had a happily demented gentleman whip it out and urinate on the ground next to me.  In all of these situations I remember a deep underlying feeling of compassion (yes, even with the man at the VA).  It can be so easy to only see these people for their mental illness, but this does not make up who they are.

In my mind, it is imperative to convey the message that the person I am sitting across from is not defined by their illness.  The illness is a problem separate from who they are and we as a team are in a fight against it.  They are essentially a captive that we need to free.  What I tell them will often go something like this: “I believe that there is a God who loves you. I want to let you know that you are a beautiful and wonderful child of God.  The mere fact that you are a creation of God gives you worth. You are valuable. You are not your illness.  We are going to fight and conquer this.”  I intentionally take time to understand and counsel.  This will often get me behind, but in these cases I am willing to allow this to happen so that the patient gets the proper care they need.

I hope that if you or someone you know has a mental illness, you are able to take this and know that you are valuable and that you have worth as a child of God.  You are not defined by your mental health. Choose to partner with your counselor or doctor to fight against your affliction.  If you are having thoughts about hurting yourself or ending your life please talk to a trusted friend or call the National Suicide Prevention Lifeline at 1-800-273-8255. Please pass this on to anyone you feel would benefit from this.



Prayer and Medicine: Does God answer our pleas?

For people of faith, it is very clear that prayer is an effective form of treatment for an illness. For scientific sceptics, it is not so clear.

“Can I pray for you?”  Sometimes when I reach the end of what I can do medically, it is all I can offer.  Prayer is something that has been used for illnesses since before we had modern medicine.  I’m still amazed that when I glance over the list of prayer requests from my church, more than half of them are for medical needs.  For people of faith, it is very clear that prayer is an effective form of treatment for an illness.  For scientific sceptics, it is not so clear.  As a person who has a foot in both camps, I feel I’m equipped to address the question of whether faith has any place in medical practice.  Let me share some of my experiences.

“Can I pray for you?” It was all I had to offer her as I sat across from Vanessa. She was scheduled for surgery to remove her right ovary and was in my office for an EKG and surgical clearance.  I reviewed the data in front of me.  She had been having pelvic pain so I ordered an ultrasound to investigate.  It returned showing a large golf ball sized mass that had the characteristics of cancer.  Follow up studies showed an elevated Ca-125 (a tumor marker).  All the signs pointed towards ovarian cancer.  She agreed to let me pray for her.  I remember praying specifically for complete healing.  The visit ended and we departed ways.

Two weeks later she followed up.  I knocked on the door and went in fearing the worse and ready to make the oncology referral.  To my surprise I was met with a large smile across Vanessa’s face. She couldn’t wait to relay the good news.  She had undergone the surgery and the right ovary was completely normal.  No mass, not even a cyst.  It was removed to be safe and sent to the pathologist.  She had just received word that there was no evidence of cancer on the microscopic analysis. “That’s great!” I said in shock. She thanked me for the prayer.  She credited it to the good outcome.

Another time I sat across from Stan.  His issues were not medical.  He had many medical problems but they were under control.  He became tearful after telling me he was unsure he would be able to pay for his groceries after paying for his medications that month. I got him some resources on local senior aid programs.  “Can I pray for you?” I asked as I felt there was nothing further I could offer.  I prayed for his situation and that something would open to provide him more income.  The next day I received a call.  Stan was overjoyed on the phone.  He was so excited he was stumbling over his words but I got the gist of it.  The day we prayed, when he got home, there was a friend on his doorstep looking for a place to stay and would pay rent.  His financial situation was solved! “And they say God doesn’t answer prayers!” he said facetiously as we hung up.

The above stories are wonderful and I wish that all of my prayers turned out so well.  Unfortunately, the majority of my prayers go “unanswered.” I pray for healing and it doesn’t happen.  I pray for help for an addiction but it only worsens. I pray for psychological rest and it doesn’t come.  So were the above stories coincidences?  Random serendipity with the odds landing in their favor? Let’s look at another patient.

It was a difficult visit.  Eric had been diagnosed with bladder cancer that had not been fully resected during surgery due to its aggressive nature.  Exam showed the mass was evolving quickly and was now the size of a softball just below his belly button.  He was pacing back and forth because sitting down produced too much pain.  He was in the office for a hospice referral.  Hospice is a great service for those who are headed towards death to ease their pain and discomfort.  With the aggressive nature of the mass, if it continued, death would be inevitable and soon.  “Can I pray for you?” I asked.  Again, it was the only thing I could offer.  He agreed and he and his wife bowed their heads as I petitioned God for relief and more specifically for healing. God didn’t answer my prayer.  Eric died 2 week later.

This last example seems to be more common. Was Eric unlucky?  Why had he not been blessed with God’s healing and answered prayer?  These questions haunt me.  I house doubt in the back of my mind everytime I pray due to the possibility that the prayer may not be answered.  Those of a calvinistic or predestination background may ask the question “Why even pray?” if God is unchanging and our paths are laid out.  I would tend to lean the other way with a more open theology believing that God is open to change and can be swayed by our intercessions.  One needs look no further than Genesis where Abraham pleaded with God to save Sodom talking Him down to just 10 righteous souls.  If this is the case, God welcomes our prayers to petition his grace.  In Romans 8:26 it states that the Spirit intercedes for us and again in 8:34, Jesus intercedes on our behalf.  If the Spirit and Jesus do it, shouldn’t we? That’s what the Bible says, but what does Science say?

I decided to try and find this out.  I did a literature search for double blinded studies on “intercessory prayer” (the act of praying for someone else’s healing) and reviewed the studies.  Perhaps the most famous of these and most often quoted is the STEP trial (Study of the Therapeutic Effects of Intercessory Prayer). Participants in this study were placed into 3 groups: those receiving prayer without knowledge of it, those not receiving prayer without knowledge of it and those receiving prayer with knowledge of it.  They then measured the rate of complications after heart surgery in all groups. The results were statistically significant and showed no difference in those without knowledge of whether they were prayed for or not (52% and 51%) while there were more complications in the group that had prayer and knew about it (59%).  What does this mean? It was postulated that prayer has no effect on outcomes and when patient’s knew they were being prayed for, they had worse outcomes due to increased stress of trying to live up to the prayer.  One thing they didn’t consider was the possibility that maybe God’s grace extends to those who aren’t being prayed for.  Scientist’s will however point to this study as evidence that God does not answer prayer and complications are going to happen in some people no matter what.

Another study on the effect of intercessory prayer in the treatment of alcohol abuse “did not demonstrate clinical benefit” but also added “Prayer may be a complex phenomenon with many interacting variables.”  Contrary to this, there are other studies that do show a benefit of prayer.  One study found “Remote, intercessory prayer was associated with lower CCU course scores (less complications). This result suggests that prayer may be an effective adjunct to standard medical care.” There are more studies beyond these that have data to back up both sides of the argument for and against the efficacy of prayer.

So where does this leave us?  We have conflicting results from personal stories and we have conflicting results from scientific studies. The scientist in me wants more information so I can make a definite stand on one side or the other. Right now we don’t have that information.

Here are a few reasons why science may never be able to answer this question.  First, there is no way to control confounding variables in prayer.  Even those who had “no prayer” in a study may have a mother pray for them every day.  Second, trying to study the supernatural is practically impossible.  By definition, something that is supernatural is beyond scientific understanding and transcends the laws of nature.  Randomly controlled double blinded tests (our best type of scientific test) may be inadequate to measure results. Last, prayer is tied to faith and there is no good way to test the faith of the person praying the prayer.

In my opinion not having scientific answers is a good thing. If we were able to scientifically prove the efficacy of prayer, I fear that it would take away from the faith behind those prayers.  Prayer is not effective because it has power, it is effective because we believe in a God who is powerful enough to answer those prayers.  I pray because I put my trust in God.  I know that moving forward I will continue to pray for my patients.  I will try to point them toward a loving God that wants nothing more than to know them and walk through life with them (especially during the hard times of illness, addiction, medical uncertainty and mental anguish).  I will continue to offer them and you my open invitation, “Can I pray for you?” Please accept the offer.

 

REFERENCES

Benson H, Dusek JA, Sherwood JB, Lam P, Bethea CF, Carpenter W, Levitsky S, Hill PC, Clem DW, Jain MK, Drumel D, Kopecky SL, Mueller PS, Marek D, Rollins S, Hibberd PL, – Am. Heart J. – April 1, 2006; 151 (4); 934-42

Walker SR, Tonigan JS, Miller WR, Corner S, Kahlich L, – Altern Ther Health Med – November 1, 1997; 3 (6); 79-86

Harris WS, Gowda M, Kolb JW, Strychacz CP, Vacek JL, Jones PG, Forker A, O’Keefe JH, McCallister BD, – Arch. Intern. Med. – October 25, 1999; 159 (19); 2273-8