Fears and Phobias

Without some good, sensible fears, we would live very short and perilous lives. Healthy fears keep us from engaging in dangerous and foolish behaviors that could cause tons of grief.

That’s why we wash our hands after using the bath room, stop and look both ways before crossing a busy street, and make sure the ladder is secure before using it to clean out the gutters on the house.

But phobias, irrational fears that get in the way of normal activities most people do as a matter of course, are anything but helpful.

For example, if we panic at the thought of being in large crowds, break into a sweat traveling over high bridges, or have an anxiety attack thinking about using an elevator, we’re experiencing distress for no good reason. And since our impulse is to always avoid whatever causes us emotional discomfort, we may use a lot of time and energy trying to accommodate our phobias.

The good news is that these unwelcome and non-useful fears can be overcome. And the process is really very simple, though simple and easy are not the same thing.

I sometimes ask my anxious clients to imagine needing to overcome a fear of non-poisonous snakes. What if the only job they could get would be at a pet shop where they would be expected to take care of snakes and to show customers how to handle and take care of them?

We usually agree that a step by step approach might actually work. One might first stand close to a caged snake and observe it carefully and at length, then engage in some mental rehearsal, imagining touching it while repeatedly reassuring ourselves this is absolutely safe. Another step might be to have someone else hold a snake in our presence, then begin to hold the tail end of the reptile while a coworker holds the other end. Later we could reverse that, until we could hold one on our own with someone else present. Finally, we would practice doing it alone, repeatedly, until we would no longer have the slightest qualms about handling a snake.

These are simple steps that are guaranteed to work. In fact, all of us have overcome phobia after phobia in just that way, one baby step at time. Some examples might include an irrational fear of being alone in the dark, of giving an oral report in a class, of driving a car on a busy highway, or of taking on some new assignment at work.

The reason we are successful in accomplishing these is because we practice doing the opposite of what our instincts tell us to do. In other words, we move toward the object of our fears, in incremental steps, rather than away from them in order to avoid them. Every time we move just beyond our normal comfort zone, we expand it, and thus become able to do more of the things that other good, mature adults do all the time.

In other words, we begin to live by our faith instead of our irrational fears.

A Little Hope Goes a Long Way

I remember as a child going on a mountain hike one hot summer day with some of my older siblings and their friends. It didn't take long for me to get so tired I began to lag behind the rest. And the further behind I got, the more exhausted and terrible I felt, yet I didn’t want to admit I needed help.

Finally someone noticed and suggested the group pause to let me catch up. Then that kind person took my hand and walked with me for the rest of the climb. I can’t even remember who it was, but I’ll never forget how much better it made me feel. Even though we continued to move at a good pace, I actually experienced new physical as well as emotional energy to reach the top with the rest.

A little help and a little hope goes a long way.

I sometimes ask my clients to rate their emotional state on a scale of 0-10, a ten meaning they feel euphoric or ecstatic (something we rarely experience), zero meaning they are suicidally depressed (which most of us, thankfully, also rarely experience), and five feeling just average or so-so, neither really bad nor especially good. Distressed clients often report a current mood range of about 2-4, as compared to a wished for 6-8.

Being mentally healthy has as much to do with our level of functioning as it does with the state of our feelings, but our mood levels are an indicator of our general state of well being. So what can we do to stay up, feel reasonably positive, more of the time?

A key factor, I believe, is to restore a greater sense of hope. No matter how bad things are in the present, or have been in the past, if we can borrow--from the good Bank of Hope--some evidence-based belief that things will get better, then we will be able, with God’s help and the help of other good people, to feel and to function better, and to keep up the fight. The Bible actually defines faith as "the substance of things hoped for, the evidence of things not (yet) seen."

Being suicidal, by definition, is to experience the loss of all hope, to believe that there is absolutely nothing to look forward to but more despair. This means that unless my clients are actively suicidal, I assume they still have at least some hope, if only through believing that seeing a therapist might help them get better.

It is this kernel of faith, even if its only the size of a grain of mustard seed, that I want to build on to help them deal with the mountain of distress they feel stands in the way, and either to have that mountain removed or to be able to find a way around or over it.

Not surprisingly, in drug trials that are done for testing the effects of antidepressants, there is always a control group that is given a placebo, a so called sugar pill. Amazingly, that group often experiences nearly as much relief from depression as do the ones actually taking the drug. This isn’t just because they trick themselves into believing they are less depressed, but because the very hope of getting better releases good endorphins in their brains, a natural drug, if you please, that makes a real difference in their well being.

A helpful web site I discovered recently for individuals dealing with mental illness is called, appropriately, www.mentalhope.wordpress.com.

Some Reflections on Tuesday’s Forum (updated and revised)

WHO: Some fifty concerned citizens, including attorneys, social workers and mental health professionals and three panelists: Rockingham County Sheriff Bryan Hutcheson, Sarah Albrecht, licensed professional counselor at the Community Services Board and David Rawls, psychologist at Western State's 45-bed forensic unit (serving persons convicted of some crime).

WHAT: A forum on the treatment of mentally ill and suicidally depressed inmates at our local jail.

WHEN: Tuesday, March 6, from 12-1:30 pm.

WHERE: Massanutten Regional Library meeting room.

WHY: To consider humane alternatives to the use of the restraint chair or the padded isolation cell for suicidally depressed inmates (see blog on this topic), including the use of volunteer mental health professionals to be available to be with such persons on a rotating, round the clock basis if necessary.

Sheriff Bryan Hutcheson agreed that the restraint chair should be used only in cases where an inmate is out of control and in danger of harming him or herself or others, and that being confined to the padded cell (where suicidally depressed inmates are stripped of their clothing and given only a paper gown to wear, and are without any reading material, bed, mattress or blanket, and with a hole in the floor for a toilet) should only be an option of last resort. However, he stressed that jail security and the protection of inmates is his first priority, along with the need to follow strict Commonwealth of Virginia guidelines and to avoid the risk of liability if any volunteers assisting such individuals were injured.

Sarah Albrecht, LPC, reported that the CSB is able to provide the equivalent of about 1.5 mental health counselors or psychiatric nurses (a full time equivalent number that was only her estimate, so it could be higher) for an overcrowded facility which houses 345 inmates who have little or no outside human contact or access to any other mental health resources. This is no fault of the CSB, of course, which also offers several educational groups led by the five part time CSB persons who make up that 1.5 or more number (including the psychiatric nurse practitioner who oversees the use of meds) but little counseling is offered.

Psychologist David Rawls reported that at Western State padded cells are no longer used for the patients from other jails and prisons housed there, but suicidal inmates are given one-on-one oversight, and the restraint chair is used only when there is an incorrigible patient. He also reported the use of trained peer support persons assigned to suicidal inmates in some prisons, but offered no details.

In summary, given the perceived risks, I left the meeting with little hope for any significant change in the near future in how our local jail deals with mentally ill inmates. However, Sheriff Hutcheson did say he is always open to at least meeting with any concerned citizens to hear their concerns, and stated that more training of jail personnel is a priority, with one deputy already being specifically assigned and trained to work at coordinating services to inmates with mental health needs.

I remain interested in generating a list of people who would be willing to further investigate workable and humane options that would not strain already stretched personnel and resources at the jail. My goal would be to both offer support to our new sheriff and promote better services to those citizens to our community who are behind bars.

Meanwhile, it would be interesting to know how many of our local inmates are actually being confined because they are guilty of violent crimes, and what percentage are in fact being detained for no crimes at all, but for technical parole violations, failure to pay child support, etc. I would also like actual statistics on the number of unarmed persons holding Sunday services or offering classes at the jail who have ever been threatened or harmed.

Your ideas are welcome, and please let me know if you are interested in being a part of further conversations with the Sheriff on this and other jail related concerns.

Jail is no Place for the Mentally Ill

According to a 2008 Virginia state mental health commission report, an estimated 15 percent of inmates in our prisons and jails are suffering from some form of mental illness. Since the number of patient beds in state mental institutions like Western State Hospital has been drastically reduced through the deinstitutionalization initiated in Virginia several decades ago, available space for mentally ill adults in such facilities has dropped from over 10,000 to fewer than 2000.

Unfortunately, far too many of these citizens have ended up in prison as a result of their inappropriate behaviors or threats of harm to themselves or others. Our jails and prisons are ill-equipped to handle such cases.

For example, in dealing with inmates who are suicidally depressed, our local jail has seen itself having only one of two options, the restraint chair or the padded isolation cell.

The restraint chair is one in which an inmate is strapped and kept in an upright position for hours on end, without access to mental health treatment or any kind of normal human interaction.

The padded isolation room, unlike a regular solitary confinement cell, has no cot or mattress and no sink or commode, only a hole in the floor to be used as a toilet.  Before being placed in the cell, the person is stripped and given only a paper gown to wear. No reading or writing material is provided, and human contact is limited to jail personnel bringing in food (with no utensils, for safety reasons) and some strips of toilet paper when requested.

From the perspective of jail personnel, they feel they have no other options. They don’t have the staff, training or budget to provide mental health treatment. Someone from the Community Services Board may be called in for an assessment, but actual counseling help is normally not available.

Understandably, the jail’s primary responsible is to ensure inmate safety and security. But a caring community as rich in resources as ours can do better than that, given the fact that, for an emotionally ill person, this kind of restraint and isolation can only serve to worsen their mental condition.

I have no easy solution to offer, but I am pleased to say that in a meeting I had yesterday with our new sheriff, Mr Hutcheson, he has agreed to be a part of a community forum at the Mssanutten Library Tuesday, March 6, from 12-1:30 to explore constructive options.

For starters, I suggest they might include the following:

1) Whenever possible, confine suicidal persons to regular segregation cells, with trained community volunteers (through our Community Services Board?) present for designated shifts around the clock to assure safety and provide for human interaction. These could include people like graduate level counselor interns and retired mental health professionals or clergy.

2) Provide appropriate reading and writing material.

3) Offer professional therapy on a regular basis through the CSB or with trained interns from JMU’s or EMU’s Masters in Counseling programs, always looking for practicum sites.

These are only some beginning suggestions, and any long term solutions must include having more bed space at institutions like Western State Hospital.

Meanwhile, if we work together, we can find humane solutions for mentally ill prisoners that will neither overburden the jail’s budget nor its personnel.

The Wise Brain and the Wild Brain

we’re all born with ancient brains from back when we hunted on the plains,
and though an awful lot has changed, we still chase the things we taste:
salt, sugar, sex, starch, fat and love—we crave all of the above,
and it feels right when we find them, but we can never get enough...

                                                                  Brad Yoder, 2011, all rights reserved

Sometimes I show the above diagram to a client to illustrate how we humans tend to make decisions, wise and otherwise.

The lower part of the brain, the subcortex, I point out, is the part of our complex nervous system that is much like that of the rest of God’s creatures. It is the primitive, reactive part of the brain designed to help us survive, the part that generates the arousal needed for our “fight or flight” responses to perceived threats. It’s an important asset when there is a fire, an accident or any other immediate or possible danger, and is also the part of us that regulates body functions and urges us to satisfy our cravings for food, drink and sex. 

The higher brain, the neocortex, represents our amazing capacity for reflection, reasoning and creative problem-solving, and in my opinion is the part of us that most represents the image of God. It is here that we can make wise and thoughtful decisions, "wise" representing the kinds of actions we will later feel the least remorse about, and "foolish" being the kinds of impulse-based behaviors about which we are most likely to have profound regrets.

It is of course possible for this higher brain to come up with all kinds of nefarious and unwise schemes as well, depending on the moral values of the individual.

At any rate, when the lower part of our brain is highly activated, is in that impulsive mode in which strong feelings of fear, anger, or desire are escalating, the upper brain is half shut down, is more likely to just be ignored or bypassed. Which may be called for, even lifesaving, in case of a real emergency requiring immediate and drastic action, but catastrophic in life situations that call for careful choice-making.

All too often we humans tend to overreact to situations, perceiving them as crises when they simply represent normal problems. As a result we find ourselves behaving inappropriately, from the reactive rather than the reflective cortex of our brain.

All of the above is vastly oversimplified, of course, in that our brains are far more complex than I’ve described, but I still see this as a helpful picture to keep in mind. We’re surely better off being mindful of which part of our brain is calling the shots, and to make sure we are making wise, life-enhancing choices we’ll feel best about--and blessed by--one, ten or fifty years from now.

So much depends on whether the wise brain or the wild brain is in charge.

Contemplative Action

Some time ago my good wife asked me to make a list of all of the extracurricular things I’ve gotten involved in in our community, one I admit turned out to be even longer than I thought.

Which caused me to think more seriously about creating a healthier balance in my life between work, community and church involvement and my personal, spiritual and family life. Have I become a workaholic, an all-too busy human doing instead of a healthy and balanced human being?

I’ve been benefiting from reading a book my daughter gave me on “The Active Life--A Spirituality of Work, Creativity and Caring,” by Quaker author Parker J. Palmer. He suggests that instead of separating the contemplative and the action parts of our lives, or simply alternating between the two--with contemplation being primarily about becoming revived and renewed to go back to more action--that we do more of integrating the two, practicing contemplative action and active contemplation.

Palmer goes on to stress the value of work as an important and life giving part of who we are and how we contribute to our communities, rather than just being our way of earning a living. He also stresses the need to place high value on creativity, whether that be in gardening, raising and nurturing a family, or writing a poem or essay.

Another important element we want to integrate into our everyday lives, he says, is caring--visiting a sick or elderly neighbor, expressing love and support to a spouse or family member, or promoting projects that improve the well-being of the community and the world.

Can all of these be done in a way that reflects a healthy balance?

I hope so.

The Wise-Self/Worried-Self Journal

For any of us dealing with an overload of anxiety, anger or depression, I suggest using a journal as a daily “Worry Book”  in which we do what I call “double-entry journaling.”

Here’s how it works:

On one side of an open journal page we write down our worst fears, worries, angers, griefs or negative beliefs. We record these in raw, unedited form, just as they are repeating themselves endlessly in our mind. This step can help us identify, externalize and vent the negative messages that are coming from our fear-based “worried self.” Putting these distressing, repetitive thoughts and beliefs on paper helps us examine them more objectively to see if they pass the truth, faith and reasonableness test.

Examples of negative, "worried self" statements:

“I’m always messing up. Nothing I do or say ever comes out right.”

“My boss has it in for me. Everybody else at work gets treated better than I do.”

“Everything is just so hopeless. Life is totally unfair, and there’s not any use even trying to make things better.”

When we’re finished getting these off our chest we turn to the opposite page and write responses to each of our expressions of distress or fear, this time speaking from our “wise self.” This doesn’t mean writing down a lot of Pollyannish platitudes simply to make us feel better. Rather, we respond in the same way we would if this worried or depressed person were some other valued friend or family member we really cared about.

Here are some examples of “wise self” responses to the above:

“I’m human, so I do mess up sometimes. But of course I say and do some things right, too, and when I goof up, I can always learn from my mistakes.”

“My boss is unreasonable sometimes, for sure, but that’s his/her problem. My problem is knowing how to either ignore her/him when s/he’s having a bad day, confront him/her about it, or find myself another job.”

“I guess not everything is hopeless, even though some things do seem unfair. With God’s help and with the support of other good people, I can at least do my best to make my life worthwhile.”

When we’re finished reflecting on all that is unreasonably negative (on the left page), and finished affirming alternatives that are reasonably positive (on the right page), we close our “Worry Book” and set it aside, having done as much as we feel we can for the time being. Then whenever we need to, if not on a daily basis, we return to the book, review what we’ve written on both sides of the ledger, add to each column whatever is current, and again close it and set it aside. And then go about living under the guidance of our wise, faith-based and fear-free self to the best of our ability.

Living from our more reasonable, faith- and truth-based side won’t rid us of all our problems, but it  can go a long way to reduce, if not always eliminate, a lot of the anxiety or distress associated with them.

Bottom line: The truth is our friend, and will set us free. If it isn’t freeing us, it probably isn’t the truth.

For another helpful practice for the anxious: https://harvyoder.blogspot.com/2017/11/rx-for-anxious-dedicated-worry-hour.html