«Sally Patton UNITARIAN UNIVERSALIST ASSOCIATION BOSTON Copyright © 2004 by the Unitarian Universalist Association of Congregations. All rights ...»
Even an appropriate diagnosis does not necessarily ensure acceptance or compliance with treatment. Carrie Fisher, the actress best known for her role as Princess Leia in Star Wars, talks about her continual struggle with accepting her diagnosis of manic depression. Although she started seeing a therapist at the age of fifteen, she was only diagnosed with bipolar disorder at age twenty-four. She recalls, I didn’t like the diagnosis. I couldn’t believe the psychiatrist told me that. I just thought it was because he was lazy and didn’t want to treat me. I was on drugs, too, at the time, and I don’t think you can accurately diagnose bipolar disorder when someone is actively drug addicted or alcoholic. Then I overdosed at 28, at which point I began to accept the bipolar diagnosis.... So maybe I was taking drugs to keep the monster in the box.22 Many people in the psychiatric recovery movement feel that their diagnoses made them worse because others then focused on their disorder instead of on them as individuals who were coping the best way they knew how. Any odd behavior was seen as evidence of the disorder, when it would have been tolerated in another person.
In the case of an eating disorder, both the individual and his or her family are often in denial about the condition. This means that it is usually hidden and surrounded by guilt, shame, and unhappiness. Given the severe health consequences of eating disorders, as well as the mental and emotional pain they cause, it is critical to get help for anyone who might be suffering from such a disorder. In our roles as ministers and religious educators, we can seek advice from professionals or contact ANAD about their CONFRONT program on how to approach the individual and his or her family.
135 Mood Disorders We do not have the training to make diagnoses, but our experience working with children should give us a sense of when something is not right. Acting on that sense can be difficult, however, especially when ministering to parents who are in denial about their child’s mood disorder. Denial is more common when the child is young, as parents find it easy to believe that he or she will outgrow the disturbing behavior. As religious educators and ministers, we have to tread very carefully with parents. All we can do is gently suggest that they seek a professional opinion and then support them no matter what they decide.
Our opinion may be better received if it is well informed;
namely, we need to be aware of the factors that place a child at risk for developing depression. In Help Me, I’m Sad, Fassler and Dumas describe eleven risk factors and point out that the interaction and cumulative effect of these risk factors is of critical importance.
Some of these risk factors are influenced by family dynamics and
therefore will affect how we minister to families:
• A child is more likely to develop depression if one or both parents have a history of depression.
• Stressful life events—such as hospitalization, an illness in the family, going to a new school, a change in the parents’ financial situation, breaking up with a girlfriend or boyfriend, and failing in school—can cause a child to feel depressed. This kind of depression usually passes, but if a child experiences a series of traumatic losses (such as the death of a parent or sibling, the parents’ divorce, a natural disaster, or violence), he or she may develop serious depression.
• Child abuse, inconsistent or unstable caregiving, parental substance abuse, and conflict between parents can cause a child to be depressed.
• Children who have been diagnosed with a disability or are otherwise seen as different can experience isolation, unpopularity, and loss of self-esteem, which make them more vulnerable to depression.
136 Welcoming Children Of course, the most serious worry about someone who is seriously depressed is that he or she will commit suicide. We need to be aware of the risks for child and adolescent suicide.
We have limited time with the children in our religious education ministry and may not have the opportunity to observe the signs of depression. However, when we know that a child has a mood disorder that puts him or her at risk for suicide, we can be sensitive to changes in that child. For instance, a dramatic change in a child’s behavior—say, from engagement to listlessness—over several Sundays is reason to talk with the parents.
The American Foundation for Suicide Prevention suggests the
following steps if a child is suspected of being at risk for suicide:
• Take the child’s actions seriously.
• Talk to the child’s parents.
• Insist that the parents get help from a medical or mental health professional or help them to do so.
• Support the child and encourage the parents to listen to him or her.
• Avoid undue criticism and remain connected.23 Tuning in to the observations of peers is also useful in determining if a youth is at risk, as adolescents often know when something is wrong with their friends. Teach youth groups about suicide prevention. General guidelines include taking a friend’s actions seriously; encouraging the friend to seek professional help and accompanying him or her if necessary; talking to a trusted adult; and not trying to help the friend on one’s own.24 It is also critical to provide a support network for children and youth coping with a peer’s suicide, as all of them will experience symptoms of posttraumatic stress disorder (PTSD). According to the National Center for Post-Traumatic Stress Disorder, these symptoms can be debilitating and must be taken seriously. 25 (More information on PTSD is provided in the chapter on anxiety disorders.) 137 Mood Disorders Ideas for Teaching Unlike physical and developmental disabilities, mood disorders are often attributed to a lack of emotional well-being. Thus, it is appropriate for a faith community to minister to children with mood disorders from a spiritual perspective. This will not resolve or eliminate the factors behind the mood disorder but instead will provide a context for exploring the human condition.
As religious educators and ministers, we all know children and youth who see the world as a negative, unforgiving place. Ironically, it is these pessimistic children, who are trying to protect themselves from disappointment, who are often susceptible to depression. Helping them connect to the divine within and to see the world as a sacred, wondrous place can help lift the pain of their mood disorder. And for those having difficulty with personal relationships, being part of a faith community can promote feelings of acceptance and understanding. As religious educators, we can create a climate in which all children are loved and cherished.
In Raising Resilient Children, Robert Brooks and Sam Goldstein describe how one charismatic adult can make a positive difference in the life of a struggling child. That adult is someone who listens, cares and supports, sees the strengths in the child rather than just the problems, and is consistently present in the child’s life.
Often, it takes only one charismatic adult in a troubled child’s life to lift him or her out of despair and stop self-destructive behavior.
Ideally, that adult is a parent, but it can be someone else. A religious community can be an excellent source of charismatic adults.
We can all play this role in children’s lives by following these
• Listen carefully. If a child is having serious difficulty fitting in or is posing a behavior problem in the religious education program, listening carefully to his or explanation of the situation without judgment is absolutely necessary for understanding the child’s perspective and ministering to him or her. Listening 138 Welcoming Children patiently to one struggling child can be difficult if there are only two adults in a room full of children. And if there is only one adult, it will be impossible. Thus, we need to make sure that enough adults are present in religious education groups that we can meet the needs of all our children. If we cannot provide a patient listener within the program, we must be sure that someone listens to the child outside the program.
• Respond genuinely. Difficult children need to know that people care about them. In particular, they need to know that we can dislike their behavior but still care about them as people. Try to look beyond the behavior to identify what you like about each child, and then tell him or her about it. Also be clear about what behavior is expected and what you and the other adults in the program can do to help the children. If, for some reason, a child is removed from the program, let that child know that you will not give up on him or her and that you will stay in contact until everyone agrees that he or she can comfortably return.
• Love and support the real child, not the troublesome behavior.
Some children become very good at hiding their true selves because they have come to believe that they are bad, uncontrollable, difficult, and worthless. Our ministry can help them reshape that perception and see themselves as unique children of the universe and that there is nothing they can do to destroy our love for them. As members of our faith community, they need to hear our spiritual thoughts and beliefs of hope.
• Create ways to understand others. Some children with mood disorders are so embroiled in their own difficulties and depressing thoughts that they have no understanding of what other children are experiencing. Finding ways for them to help others can open doors of understanding and ease their own pain.
• Work with parents. Many parents are quite knowledgeable about their children’s needs and what does or does not work in encouraging acceptable behavior. Work with parents to recognize the 139 Mood Disorders signs that explosive or troublesome behavior is imminent and defuse it. For example, an older child may be able to recognize when something is about to trigger a bout of rage, and his or her strategy may be to leave the room and find a quiet place to calm down. As teachers, we need to be aware of this and provide a safe place for the child to retreat. In addition, we need to ensure that the other children in the group know why it is acceptable for this child to leave the room.26
• Practice visualization, guided meditation, and prayer. Helping children connect with a higher power or sense of transcendence can provide hope and a connection with what is sacred and meaningful in their lives.
• Restore hope continuously. It cannot be stated too many times that hope helps people heal. Children depend on adults to provide that vision of hope. We can provide hope by believing in each child and by providing ways for him or her to feel accepted, loved, and worthwhile. Children gain hope by experiencing positive results from their actions. We can set up a win/win situation for every child.
Anxiety Disorders Toxic worry is a disease of the imagination. It is insidious and invisible, like a virus. It sets upon you unwanted and unbidden, subtly stealing its way into your consciousness until it dominates your life. As worry infiltrates your mind, it diminishes your ability to enjoy your family, your friends, your physical being, and your achievements because you live in fear of what might go wrong. It undermines your ability to work, to love, and to play. It interferes with your starting a new task or even enjoying the completion of an old one.
—Edward Hallowell, Worry, Hope and Help for a Common Condition Most of us know how it feels to be anxious or worried. We can feel anxious about a new job, speaking in public, waiting for our teenage child to come home, driving in an unfamiliar city, meeting new people, or handling an unfamiliar situation. Anxiety is tied into our basic biological survival mechanism. It can keep us alert in a potentially dangerous situation.
Most of us have the internal coping skills to reassure ourselves before anxiety becomes debilitating. We know the anxious moment will pass without doing us harm. But children often do not have enough life experience to cope with their anxiety. They need adult intervention and support to teach them how to cope and to realize that anxiety can sometimes be useful and that it will always go away.
140 141 Anxiety Disorders Given the prevalence of high anxiety in our culture, it is more than likely that we have children with anxiety disorders in our religious education programs. In most cases, because we see the children in our programs for a limited amount of time, highly anxious children pose no problems. If the anxiety becomes severe, however, the child may want to avoid church. Many parents will stop bringing their children rather than face a constant struggle. To minister to these children and their families, we can provide clear expectations while fostering a sense of connectedness to self and others and offering imaginative and creative programs that engage and support the children.
Description Professionals use many terms to describe children who need professional intervention and treatment, such as extremely anxious, overly worried, overly sensitive, and very fearful. Children have an anxiety disorder when their fears are out of control and interfere with their daily activities.
There are a number of types of anxiety disorders, and as with mood disorders, the types are not discreet, which makes diagnosis a subjective process. Moreover, some children experience more than one anxiety disorder, further complicating diagnosis. Children may exhibit their anxious feelings with behaviors such as crying, tantrums, freezing, clinging, avoidance, and headaches or stomachaches—none of which are unique to anxiety disorders.
So, when does normal anxiety reach the level of a disorder? An anxiety disorder is distinguished by its debilitating effect in terms of limiting daily activities. These disorders can be successfully treated, however, provided an accurate diagnosis is made. The following are the basic types of anxiety disorders.