Ruah books

The Holy Longing: The Search for a Christian Spirituality - Ronald Rolheiser

Care of Mind/Care of Spirit: A Psychiatrist Explores Spiritual Direction - Gerald May

   Ruah's back! And I hope to keep up better with the required reading this year.
   When I started the class, I assumed doing the reading would be one of my favorite parts, but I've been disappointed, or I've disappointed myself. Generally I've found the books (some of which I'd read before and deeply enjoyed) boring and frustrating. Overwritten. Uninspired. Blah Blah Blah. I'm projecting my depression onto them, I know! But, still, it's not like I haven't enjoyed other books over the past year.
   I think I'm in a mental and spiritual spot where theology is baloney, sermons are intolerable, nobody knows what they are talking about. I'm in the mood, spiritually, for specific instructions, silence, or riddles.
   All that said, these two books were good, if a bit wordy. Specifically I appreciated Rolheiser's main thesis, that spirituality is how we respond to our deepest desire, our divine madness, our natural maladjustment. We're not happy creatures that sometimes have problems, we're problematic creatures that sometimes get happy. Spirituality is about staying in touch with and channeling this deep longing in healthy ways.
   May's book is helpful in distinguishing between psychotherapy and spiritual direction, while maintaining links between the two. He is all for cross-pollination, but encourages practitioners to hone their specific purposes. Psycotherapy is geared toward identifying and solving psychological problems. Spiritual direction aims to help the directee to hear God in their life.
   May is both a psychiatrist and spiritual director, which is awesome and gives him great tools to write this book. But I'd love to read a book studying spiritual direction techniques and its effects written by a non-religious psychiatrist or behavioral scientist. Are there such books?



notes

Holy Longing

• God-given fire, desire, longing, madness, eros: what we do with that is spirituality, how we channel it
• "energy is not just difficult to access, it is just as difficult to contain once it enters"
• "pray, fast, and give alms"... 4 non-negotiables "a) private prayer and private morality; b) social justice; c) mellowness of heart and spirit; d) community as a constituitive element of true worship"
• "To be a saint is to be fueled by gratitude, nothing more and nothing less"
• "Our loved ones live where they have always lived and it is there that we will find them."
• "John Shea once suggested that the heavenly banquet table is open to everyone who is ready to sit down with everyone."
• "Shower those you love with flowers and affection while they are alive, not at their funerals."
• "To deal with Christ is to deal with church."
• Pascal cycle
• Name your deaths (crucifixion)
• Claim your births (resurrection)
• Grieve what you have lost and adjust to the new reality (40 days of appearances)
• Do not cling to the old, let it ascend and give you its blessing (ascension)
• accept the spirit of the life that you are in fact living (pentecost)
• "When we fail to mourn properly our incomplete lives then this incompleteness becomes a gnawing restlessness, a bitter center, that robs our lives of all delight."
• sexuality as basic fire: lead to creativity, co-creation with God
• "What Janis Joplin is saying is that, in our sexuality and our creativity, we are ultimately trying to make love to everyone."

Care of Mind/Care of Spirit

• "the primary danger in bringing these dimensions together [psychotherapy and spir direction] is that mental and emotional concerns may kidnap the gentle spiritual attentiveness required of both director and directee
• four forces in human spirituality
• longing for God
• God's longing for us
• internal fear and resistance
• evil
• unitive experiences - can't be aware of it in the moment (otherwise wouldn't be "unified"), can't achieve it or cause it 
• "in the absence of clearly identifiable disorder, it is terribly destructive to encourage the dulling or denial of this deepest existential discomfort, for this is one pain we are not meant to anesthetize ourselves to...
• basic trust and mistrust (Erikson)
• self-image
• strength - how stable and defined/fixed is self-image
• quality - how do you evaluate self (good or bad, high or low esteem)
• importance - how attached are you to it; how much do you depend on it
• "we maintain neuroses because hey represent an unconscious "solution" to deeper psychological threats
• attend to relationship between spiritual experience and social/family life
• required physical labor and voluntary exercise usu. have different psychological effects
• dark night experiences usu not associated with loss of functioning (as opposed to depression)
• "it is my belief that the primary task of spiritual directors is to encourage within themselves this moment-by-moment attention towards God as frequently as possible during spiritual direction sessions
• condensation - feelings condense around other feelings
• referals

Drugs, Diagnosis, and Despair

On Depression: Drugs, Diagnosis, and Despair in the Modern World - Nassir Ghaemi

What's the angle?
   Ghaemi is a practicing psychiatrist and researcher, also very well read in the western humanistic tradition. I really enjoyed all the history of psychology and medicine he included. His chapter on Hippocrates was one of my favorites, as was his chapter on Lester Havens, his teacher. 
   On the other hand, his "clinical picture" of post-modernism was vague, watery, a straw-man, so his arguments against it didn't go over well; like a grumpy old-man.

What is depression?
   Ghaemi would like for the mental health field to make a distinction between depression disease - whose hallmark is recurrence - and depression non-disease - perhaps resuscitating "neurotic depression" as an apt term. He doesn't draw a hard and fast line between the two - there must be overlap; but his goal is to distinguish, as far as possible, between biologically based depression and psychologically based depression.
   For depression disease, he identifies genetics and early life environment as the "first" causes (the things that make the disease possible) and adverse experiences or events as the "efficient" causes (the things that trigger the disease).

How do you treat depression?

1. Medicine
   Dr Ghaemi, like many of the authors I've read, think that anti-depressants are being overprescribed, but in principle he is in favor of medicating diseases. The key is accurate nosology, and Ghaemi thinks that the DSM has lumped too much into Major Depressive Disorder. He lays out some good rules of thumb (rule of thumbs?)

• As to diseases, make a habit of two things - to help, or at least to do no harm -Hippocrates. Is the disease curable? help. incurable? do no harm. self-limiting? do no harm. "...a Hippocratic approach would avoid medications as much as possible, except where we can clearly help the natural process of healing and with great attention to side effect."
• Osler's Rule: Treat diseases, not symptoms. "if we reject disease-oriented medicine, we are left at the mercy of social forces tending toward overmedication: patients themselves; the pharmaceutical industry; and doctors' own economic interest."
• Holmes's Rule: All medications are guilty until proven innocent. Medications "need not be proven harmful; they do need to be proven safe and effective."
• Use a diagnostic hierarchy: "certain diagnoses should not be made if other diagnoses are present...mood illnesses can produce not only depression and mania but almost any psychiatric symptom."

2. Psychotherapy
   Ghaemi reminds us that not too long ago psychiatrists primarily practiced psychotherapy. Freud and Kraepelin were the founding tree trunk, and various disciples and heretics branched out with theories and therapies. Ghaemi practices psychotherapy quite a bit, and his chapters on "guides" include many in the "existential" psychotherapeutic tradition.

• Victor Frankl: an abnormal reaction to an abnormal circumstance is normal.
• We must learn to suffer. "We must try to reduce needless evil and horrible suffering where possible, but we also need to learn, not only to accept, but to benefit from, whatever suffering remains.
• Rollo May: the therapist enters the circle of the patient's existence wherever the patient happens to be...Usually, the patient comes with a problem...Whatever the problem is, May teaches that the existential therapist meets it first as a person's experience, not as pathology, nor in any other theoretical way.
• Angst and the awareness of death
• Nudging the patient toward the "I am" experience
• Leston Havens: "soundings," probing comments rather than questions
• "motor empathy," using non-verbal communication to empathize
• hold opposing theories in your head at once
• therapy is "successive acts of liberation, not moving speeches or penetrating insights"
•  "I judge the success of psychotherapy in two ways. Does the patient's appearance change? Does he get new friends?"
• the therapeutic alliance; he was convinced that this relationship was the key treatment

 


notes

• depression a sign that we are at a dead end
• using depression to help understand normal problems
• I think the old term (neurotic) - now discarded for the fancier terms "dysthymia" and "generalized anxiety disorder" - was more true to reality
• depression disease vs non-disease
• recurrence key aspect of disease
• "first cause" - genetics (additive, not Mendelian) and early life environment
• "efficient cause" - life events as triggers
• mental health clinicians should be biased against common sense, because anything that comes their way has already failed to respond to it
• depression expressed as psychic vs physical pain, in diff cultures
• disease process vs clinical picture
• the feeling comes first, the rationalization comes later
• in usa, psychiatrists prescribe meds to 82 percent of patients
• psychiatric drugs second most profitable class (cardiology 1st)
• hippocrates - nature wants to heal, physician should aid nature,
• galen - illness is lack of humoral balance, always intervene
• Osler's Rule - treat diseases, not symptoms
• Holme's Rule - all medications are guilty until proven innocent
• recent study: half of people diagnosable with mental illness not in treatment, and half of people in treatment not diagnosable
• history of DSM and depression
• Frankl - an abnormal reaction to an abnormal circumstance is normal
• learn to suffer
• Havens - goal of therapy is "successive acts of liberation"
• Havens - work with comments, empathy, rather than questions
• Havens - "just as conventions and expectations can fix a lethal straitjacket on individual differences, so standards of health on the basis of admirable traits ignore the way human situations an call up the need for the most bizarre qualities"
• "norm" - what is typical in a group
• "normal" - absence of pathological
• "ideal" - theoretical standard
• Havens - "hold your formulations lightly, and let your imaginations grow, remembering that all formulations used to be imagination"

Conquering Depression

Heavenly Wisdom from God-illumined Teachers on Conquering Depression - St. Herman of Alaska Brotherhood

What's the angle?
   The library office at Richmond Hill has a dozen or so books from the press of St. Herman of Alaska Brotherhood, mostly Russian Orthodox stuff, or things based on the Philokalia. Really cool. 
   This book begins with a very brief testimonial about Maria of Gatchina, who, during a paralyzing illness, was blessed with the spiritual gift of "consolation of the sorrowing." People from all around came to her for illumination, comfort, and counsel. Later she was imprisoned for her faith and died a martyr.
   The rest of the book is made up of teachings and prayers about depression from the Orthodox tradition, from Paul, early Greek writers and desert fathers, on up to the 20th century. The bulk of the excerpts come from 18th-20th century Russian monks.

What is depression?
   I loved both the unity and variety of this book. Depression, dejection, despondency, insensibility, sorrow, grief, despair, gloom: the authors witness to all these and more. Is this depression in the modern, western sense? Definitely so, at least by DSM criteria.
   Mostly what the monks address are prolonged periods (weeks, months, or years) of low or sad mood, a feeling of spiritual disconnection, a loss of the hope or sensitivity to life, loss of energy for their normal activities, feeling like their lives are pointless, overwhelming guilt or shame. The only criterion that doesn't appear here is suicidal ideation or attempts (except when in reference to Judas).
   Despondency may be the word most used in this collection. I'm not sure, maybe dejection or depression. I'm guessing "acedia" or a Russian version of that is the key orthodox term in play.

What causes depression?
   Again there is diversity, with common threads. Here are some diagnoses:

• the devil or a demon of gloom is attacking you, draining you, clouding your spirit and dulling your mind, trying to convince you to give up the monastic life
• God is punishing or disciplining you for some sin
• God is testing your faith; will you love God in the bad times as well as the good?
• God is forming you with the hammer of suffering and deprivation
• you're thinking too much about yourself, about what you lack, or about your past sins.
• it's part of the natural up's and down's of monastic life

Practically, it might be your fault, it might be the devil's fault, or it might be God's fault, but one way or another depression is always defined or explained vis-a-vis God. For the monastic, God is the ultimate reference point, and every experience is caused or allowed by God and, to the eye of faith, leads to God.

How do you "conquer" depression?
   You don't. According to most of these writers, if you live right, then eventually it goes away, or God sends you consolation in the midst of it. I'm not sure why the editors chose "conquer." "We are more than conquerors." It fits with the spiritual battle language, but "resist" or "endure" appear more often here. Here are some treatments:

• Repent! Drop to you knees and pray for forgiveness and begin again. Perhaps you know you have sinned or been forgetful of God. Perhaps God will reveal a hidden sin to you. (this seems a dangerous tack for someone who is depressed, but I guess it worked for many of these folks) In any case, the monk's life is one of constantly (re)turning to God.
• Resist! Don't give into the despair. Don't leave your cell, or abandon your calling. Keep up your prayers, even in the sorrow or pointlessness. Eventually you will come out of the dark cloud.
• Be humble. Bear your cross patiently. "By your endurance you will save your souls." Jesus has "sanctified the road of suffering with his feet."