“We’re All Mad Here”

“We’re All Mad Here”      Sept 16, 2018     Dr. Roger L. Ray   

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“Anthem” by Leonard Cohen

The birds they sang At the break of day

Start again I heard them say
Don't dwell on what Has passed away

Or what is yet to be
Yeah the wars they will Be fought again

The holy dove She will be caught again
Bought and sold And bought again

The dove is never free
Ring the bells (ring the bells) that still can ring
Forget your perfect offering
There is a crack in everything (there is a crack in everything)
That's how the light gets in
We asked for signs The signs were sent
The birth betrayed The marriage spent
Yeah the widowhood Of every government
Signs for all to see
I can't run no more With that lawless crowd
While the killers in high places Say their prayers out loud
But they've summoned, they've summoned up A thundercloud
And they're going to hear from me
Ring the bells that still can ring...
You can add up the parts You won't have the sum
You can strike up the march There is no drum
Every heart, every heart to love will come
But like a refugee
Ring the bells that still can ring...

            My father was not much of a theologian or a philosopher but like a lot of the elders of rural Kentucky, he maintained a treasure trove of proverbs that helped him to navigate the complexities of life. Often, when faced with either the shortcomings he discovered in himself or in his very small circle of friends, he would say, “There’s only been one perfect person and they killed him.”

During my graduate school training in Biblical studies, I discovered that the narrative that described that one person as being perfect was little more than a useful fiction, still, he was enough better than his peers that they did, in fact, kill him. I cannot recall what first brought the lyrics of Leonard Cohen’s “Anthem” to my attention but the lines “Forget your perfect offering There is a crack in everything (there is a crack in everything) That's how the light gets in”caught my attention. Forget about trying to be perfect . . . more realistically, forget about trying to convince yourself or others that you are always innocent and stop with the perpetual multi-generational lie that people try to get us to repeat about our parents, “Well, they did the best that they could.” I didn’t. I could have done better. I know that my parents could have done better. The more I get to know folks, the more certain I am that their parents sure could have done better! No one does the best that they could. The only virtue to be found in that arena is if you actually want to do better rather than constantly trying to polish your alibis. 

Give up on your pretense of having done your best. . . there is a crack in everything. Everyone is broken in one way or another. The Cheshire Cat was just being frankly honest: We’re all mad here. Cohen’s “Anthem” makes the claim that the cracks are where the light comes in. I don’t want to be Pollyannaish about this. Mental illness is serious. Autism is serious. Addiction is serious. Depression is serious.

Look, folks, suicide is now in the top ten causes of death in America. You can’t just post a meme about how in Japan they repair broken vessels with gold so that the factures become the most beautiful aspect of the pottery. Folks, you are not a potted plant… ok, most of you are not a potted plant. But still, it is true that our brokenness is a part of who we are. Our failures are more instructive than our successes. I learned more about marriage from going through a divorce than I did in all of my marriage and family counseling courses. And I learned more about theology, psychology, and myself by being fired a decade ago than I learned as a post-doctoral student at Harvard. There is something very educational about failing hard. 

The mortality rate is 100%. We are all going to die somehow. Statistically, most of us will die from heart disease, cancer, or a respiratory disease. But of all of the lethal factors in the world, suicide is the only one that is actually rising on the list. Suicide is more common than death from car accidents and gun violence. So isn’t it about time we start to get really honest about where it hurts?

This is the DSM-III, the third edition of the Diagnostic and Statistical Manual of Mental Disorders. I am now almost 40 years behind since there is a DSM-V on the desk of most mental health professionals but my other primary text is over 2000 years old so I have not felt the need to update my DSM. 

When I was doing my clinical placement in a mental health center during my graduate school education, the state of Kentucky was trying to trim their mental health budget . . . a chronic problem in the field of mental health. The legislature passed a budget that would no longer pay for treatment for most of the things we were treating our clients for. So we had a long night in Bowling Green, KY in which we took out all of our files, opened our DSM’s and re-diagnosed all of our clients with something the state would pay for. 

Now, I know that sounds fraudulent, but it is as not as fraudulent as the DSM itself. This is not a physics or a math text book. Psychology is not the same as astronomy or biology. In fact, it is more like philosophy or theology. 

The DSM is not based so much on research as it is based on the collective opinions of the therapists who sit in their offices all day, talking with the people who have come to them for help. I have worked in a mental health center. I have known the therapists fairly well, and, given fifteen minutes, I could have found plausible reason to diagnose every one of them with one character disorder or another and some of them possibly with a psychosis. But then I hale from a profession in which most of the practitioners believe in invisible angels, demons, and heaven and hell so I will readily confess that my roots are dug deep in what is clearly a lack of orientation to reality. 

We are all mad here. Everyone is, if not broken, at least cracked. Sadly, many people allow themselves to become so aware of the brokenness in others and so blissfully unaware of the brokenness in themselves, that they become increasingly isolated, judging first this person and then that one, until they find themselves to be almost entirely alone.

We live in a nation of 350 million people and one of the primary sources of suffering is loneliness. That’s just crazy. 

When it comes to the issue of suicide, research gives us a few clues as to what is leading so many people down that dark path. There are reasons in many cases . . . an incurable illness, an unbearable social humiliation, or economic despair. But more often we see social isolation, we see people who don’t want to be a burden to others, people who feel that they have no worth, no purpose, they feel that they are not needed, that they don’t belong anywhere. 

Many do not have access to appropriate mental health care. Now, there are outliers, my guess is that none of this would apply to some of the high-profile cases of people like Anthony Bourdain, Kate Spade, or Robin Williams but, folks, there is not a satisfying explanation in every case. There just isn’t. Some fish just inherently always swim upstream and they don’t all make it.

But here is what I really want to say today. I have worked in mental health. I have worked in addiction treatment. From a pastoral role, I have been a counselor to people struggling with depression, with their sexual orientation, with their history of sexual and physical abuse, and, as a pastor, I have been the victim of any number of would be career executioners who were clearly suffering from paranoia, narcissism, or a borderline personality disorder. I am all in favor of greater access to mental health care, medications, and all supportive treatments but I am totally convinced that this is not the total answer nor even 10% of an answer. 

My good friend, Dr. Jim Davis, convinced me years ago through his research in positive psychology, that neither talk therapy nor anti-depressants were nearly as effective as having close friends and exercising in sun light. You should not rely on me for medical advice. As my daughter liked to tell her friends when she was little, “My daddy is a doctor but not the kind that can help anybody.” But what my friends who are experts in the field of psychology and pharmacology do tell me is that the whole universe of serotonin drugs – Prozac, Zoloft, Celexa, Lexapro, Paxil – they all have very limited effectiveness. Again, don’t stop taking them because of what you hear me saying. 

Suddenly stopping any anti-depressant can lead to a suicidal crash. But what researches have convinced me of is that taking serotonin decreases your body’s natural production of serotonin. The benefits of taking serotonin can wear off pretty quickly but then there is a serious danger of stopping because your body is not used to making it and without it, depression can fall on you like a ton of bricks.

What Jim Davis has suggested to Olympic athletes and his college students as well as his aging friends, is to get 30 minutes of vigorous exercise outdoors every day, even when it is cloudy or cold. The combination of natural light with exercise is more effective than any prescription medication for depression. I’m not talking about medications for bi-polar disorders or any psychosis, I’m talking about the popular SSRI’s that promised so much when they first came on the market 30 years ago but the simple fact of the matter is that even with billions of pills consumed in our nation, the depression rate has gone up, the suicide rate has gone up, and the happiness of our nation has not improved. 

A psychiatrist that I referred a lot of people to when I lived in Kentucky used to tell clients, you get out of depression by putting one foot in front of another, even when you don’t feel like it. The cure is not quick or easy, but you put one foot in front of the other, then you drag the other one up and plop it down in front of you. He said, “You walk your way out of depression, both figuratively and literally.” 

I’m not saying that this is a “cure all” but I am saying that it is the most effective cure. When I am trying to help a person who is depressed, I always try to arrange for us to walk together while we talk. 

David Ketchum, our associate pastor, and I try to meet once a week to talk for mutual support and coordination of our work, but we often take that time to walk together while we talk. Look at these two images:

The solitary figure on the beach might be doing exactly what I have suggested. He is out walking in nature, and there is no where I would rather be than on a beach. But when you check your feelings, looking at a solo person on the beach and a couple on a beach, your visceral reaction is quite different isn’t it? 

Take the prospect of romance out of it entirely. Just the image of walking on the beach with friends clearly is much more effective than just walking on the beach.

For that matter, take away the beach, the prospect of romance, and even take away nice weather, and you can look at this picture and realize that walking in the company of another person makes you feel better than the thought of walking alone.

That being said, I do most of my walking alone. I listen to podcasts, I work out sermons and articles in my head while I am walking alone. I don’t mean to sound like there is not much to be said for silence and solitude but I can tell you clinically that you will never find a case of suicide caused by being overly socialized. There are people I know that I sometimes have to get away from just to let my ears rest for a while, but, you know, I always go back. 

Solitary confinement is one of the most cruel forms of punishment we know of because we evolved to be in a pack, a tribe, a community. We become avoidant of other people because people can be mean, ignorant, cruel, dishonest, and abusive. But most people aren’t. Close friendship isn’t easy because it does take volumes of trust, tolerance, acceptance and sometimes sacrifice but we shouldn’t be afraid to reinvest.

I don’t have anything against therapists, psychologist, psychiatrists, counselors, or, for that matter, pharmacists, I just think it is better not to need them. 

We tell people in addiction recovery that they need to change their playthings, playmates, and playgrounds if they want to lead a sober life. If you worked your way into alcoholism by hanging out at a bar with your friends and playing cards and you think that now you are going to just go on hanging out in the same place, with the same people, doing the same things, only with a diet coke . . . well, good luck with that. After years of sobriety, maybe that can work for you but almost everyone falls back into alcoholism unless they change their playthings, playmates, and playgrounds.

I’m trying to lose weight but I don’t resent my friends who still eat bread and french fries, but I also don’t spend my days hanging out in the donut shop. If you want to be sober, spend time with sober people. If you want to have a successful marriage, make close friends who also have and want to have a successful marriage. 

If you know that you have some serious mental health issues whether that’s depression, or phobic fears, or anxiety, then, and I’m not telling you not to see a therapist or not to take medications, I’m just saying, what I know helps is to form close connections with other people who are also trying to be healthy.

On one of our recent walks, David and I were talking about finishing our current series in our adult class and getting ready for our next book. And David was a little concerned that we don’t always get around to talking about the book in our classes but we agreed that the most important part of class is getting a number of people to engage one another in serious conversation about things that matter to them. We may not be doing the book justice but we are doing one another a great deal of good. Even when it does not feel good because there are people who irritate you. 

Community building was never about finding people who agree with you on almost everything, who share your age, gender, sexual orientation, economic class, and political affiliations. Community buiding happens when you learn to love, respect, and befriend people who are not like you and who may have extremely irritating idocyncrsies that just happen to be slightly different from your extremely irritating idocyncrisies. 

The most effective prevention of suicide is not a weekly meeting with a therapist or a pill you take when you brush your teeth in the morning. 

The most effective is to have conversation partners. Not someone who is your caregiver, your emotional comfort lap dog, but a real peer, a partner, a thinking, sentient, partner in conversation who will tell you when you are full of it and who will applaud your successes. 

A.A. is comprised of pithy little wisdom sayings and one of my favorites is, “Don’t tell me how sick you’ve been; tell me how well you want to be.” You may have been diagnosed as being borderline or bi-polar, but don’t take that as a liscense to treat your family and friends badly. You may have a mood disorder and the people around you may have to try to understand that, I know people who are clearly sociopaths, I know that, but I still expect them to do the best that they can while I try to be as tolerant as I can be. Because, folks, we all need one another and we owe one another the heathiest version of ourselves that we can bring to the conversation today. Recognizing that, no matter what, we’re all mad here.