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Reflections

Offer Hope. Prevent Suicide.

September is Suicide Prevention Month. And, September 10 is World Suicide Prevention Day. In the 80's and 90's America's suicide trend was heading down. But now its climbing up at alarming rates. Especially among girls ages 10-14. According to the World Health Organization 800,000 people take their life every year-that's 1 person every 40 seconds. Despite suicide statistics trending, all stay curiously silent. Stigma shrouds suicide. Sufferers feel ashamed to speak of it. Most of us don’t want to hear it or talk about it. But some of us don’t have a choice. We’ve had to face it first-hand.

Like V.A. Vet Manny Bojorquez, a Marine gunner who lived through 8 suicides by men in his battalion after returning from Afghanistan (Philipps, 2015). Most of us don’t deal with that level of trauma, but many of us experience the suicide of friends or a family member. When I was 10, my cousin Connie had a brilliant career as a ballerina in New York City. Despite rising to stardom at 30 something, she came home one weekend, shut the garage door, stuffed a rag in the muffler, sat in her car and turned the engine on. My aunt Gertrude found her in next morning. The car was still idling, but Connie was dead. Like Frederich Buechner’s family after his father’s suicide, “we rarely talked about it ever again to each other or to anybody else” (Telling Secrets).

More than 34,000 individuals feeling “hopeless, helpless and hapless” (Graham, 1978) take their own life each year. Suicide is the 10th leading cause of death among adults in the U.S. and the 3rd leading cause of death among adolescents. - See more at: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Suicide#sthash.az5swvD5.dpuf. For that reason high risk states like KY and WA require clinicians to be trained in assessment and prevention. Last year, I attended a training hosted by the American Association of Pastoral Counselors. Dr. Loren Townsend who won the 2012 Oates Award and also wrote a book entitled Suicide: Pastoral Responses, led our workshop. Making the point that “suicide is not new,” Townsend said that Socrates dialogued about it, Camus wrote about it and people have been “killing themselves since the beginning of time.”

Clinically defined suicide is “self injurious behavior with an intent to die” (Goldman, 2015). While suicidologists differentiate between thoughts, attempts and completions, it’s always important to take talk of suicide seriously. In 2013, 41,149 completed suicides were reported in this country and 494,169 attempts treated in emergency rooms (Centers for Disease Control). Some numbers are never reported because not all sufferers seek services (Parks, et al). Suicidal thoughts or behaviors are both damaging and dangerous and are considered a psychiatric emergency. Anyone experiencing these thoughts should seek immediate help from a physician or counselor (Bertolote & Fleischmann, 2002). And though 90% of those who struggle have a mental health condition, that doesn’t mean someone is weak or flawed. - See more at: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Suicide#sthash.az5swvD5.dpuf.

Moving from the head to the heart, feelings to commit suicide build over time into an emotional tsunami. Townsend (2015), described it as a “psyche ache of increasing pain that becomes like a toothache that won’t go away.” I’ve never struggled with suicide myself. But sitting with others  who have, I’ve seen a numbness that disassociates from life and isolates family and friends as a way to transcend unrelenting pain. When alcohol and drugs are involved it becomes a toxic mix. Believing they’re a burden to others and a “bad seed” (a client’s comment), it becomes a catastrophe that rips apart precious people created in God’s image and rupture the lives of their loved ones left behind. Aftershocks can linger a lifetime. It’s almost impossible to demonstrate causality but we can know the warning signs and learn what to do.

Know the warning signs…Threats or talk of killing themselves (known as suicidal ideation)Increased alcohol and drug useAggressive behaviorSocial withdrawalfrom friends, family and the communityDramatic mood swingsTalking, writing or thinking about deathImpulsive or reckless behaviorFeeling abandoned family, friends and GodMoral injury of an injustice suffered that can’t be forgiven-if a family member/friend or you are struggling with self harm or suicide suggest this website called a remedy to live http://remedylive.com/category/issues/suicide/ where they can chat live.

Support and share your concerns… Share your observations using “I” (instead of “you”).“I’ve noticed you’re [sleeping more, eating less, etc.]. Is everything okay?”“I've noticed that you haven't been acting like yourself lately. Is something going on?”“It makes me afraid to hear you talking about dying. Can we talk to someone about this?”“How can I best support you right now? Is there something I can do or call others to help?”“Can I help you locate  & make an appt. for mental health services and supports? “Can I help you with your errands/appointments until you’re feeling better?”“Would you like me to go with you to a support group or a meeting?”-for more see: Mayo Clinic; http://www.mayoclinic.org/diseases-conditions/suicide/in-depth/suicide/art-20044707.

Act on imminent danger when you see sufferers…Putting their affairs in order and giving away their possessionsSaying goodbye to friends and familyMood shifts from despair to calmPlanning by looking around to buy, borrow or steal needed tools to commit suicide, such as a gun, knife, drugs or prescription medicationUsing/abusing alcohol and drugs with any/all of the above behaviors-for more see: https://www.nami.org/Learn-More/Mental-Health-Conditions/Related-Conditions/Suicide.

When you are unsure how to assess risk…
  • Call 911 or your local emergency number right away. 
  • Tell a family member or friend right away what's going on.
  • Get help from a trained professional as quickly as possible. 
  • Ask your friend/family member for their therapist/doctor’s phone number.
  • Call the suicide hotline  at 800-273-TALK (800-273-8255) to speak with a counselor.

Christians aren’t immune from suicide. In fact, there’s at least 7 suicides recorded in the Bible: Abimilech, Sampson, Saul, Saul’s amour-bearer,  Ahithophel, Zimri and Judas (Meredith, 1980). In all cases there was no judgement nor moral consequences. Five were singled out for their sin. The exceptions were Saul’s armor-bearer (no comment on his character) and Samson who knew his actions would lead to his death though the goal was to kill the Philistines and not himself.

While scripture sidesteps moral commentary on suicide, it doesn’t condone it either. The 6th Commandment would seem to say suicide is self-murder (Thou shall not kill). Not only does it destroy people created in God’s image, but suicide defies the sacred trust that the Holy holds “our times in God’s hands” (Psalm 31:15). Even so the Christian response isn’t condemnation (which seems the greater sin), but compassion. C.S. Lewis’ eloquently exemplifies this in a letter to his suffering friend Sheldon Vanauken. After pleading with him that suicide won’t provide any real resolution to his pain Lewis concludes:You must go on. That is one of the many reasons why suicide is out of the question. There’s no other man, in such affliction as yours, to whom I’d dare write so plainly. And that, if you can believe me, is the strongest proof of my belief in you and my love for you” (Hooper, 2006). 

Summarizing, September is Suicide Prevention Month. While the numbers are climbing, awareness is numbing. September 10 is World Prevention Suicide Day. Prioritizing prevention the World Health Organization is inviting people to download their fact-sheet at https://iasp.info/wspd/pdf/2016/2016_wspd_brochure.pdf; to educate ourselves and raise awareness within our communities, organizations and churches. All are called to light a candle in our window on September 10 at 8pm, to raise awareness, support loved ones lost, and stand in solidarity with those who grieve. Like C.S. Lewis, may God give us courage and wisdom to offer hope and prevent suicide. 

References
Bertolote J.M. & Fleischmann A. (2002). Suicide and psychiatric diagnosis: a worldwide perspective. World Psychiatry, 1(3): 181–5.
Buechner, F. (1991). Telling Secrets, (pp 7-8). San Francisco:Harper
Centers for Disease Control and Prevention (CDC). Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2013, 2011) National Center for Injury Prevention and Control, CDC (producer). Available from www.cdc.gov/injury/wisqars/ index.html.
Goldston, D. (2015, Sept 8). Saving lives from suicide. University of Louisville Depression Center.
Graham, Victoria. (1978; July 9). St. Petersburg Independent, 3-A.
Hooper, W. (2007, p 606). The Collected Letters of C.S. Lewis. San Francisco, Harper-Collins.
Meredith, J.L. (1980, pp 143-44). Meredith’s Big Book of Bible Lists. New York: Inspirational.
Parks SE, Johnson LL, McDaniel DD, Gladden M. Surveillance for Violent Deaths– National Violent Death Reporting System, 16 states, 2010. MMWR 2014; 63(ss01): 1-33. Available from http:// www.cdc.gov/mmwr/preview/mmwrhtml/ss6301a1.htm.
Philipps, D. (2015, Sept 19). In unit stalked by suicide, veterans try to save one another. New York Times, p 1.
Townsend, L. (2006). Suicide: Pastoral Responses. Nashville: TN.
Townsend, L. (2015, Sept 23-4). Assessment, management and treatment of suicide risk. American Association of Pastoral Counselors, Midwest Fall Conference.

Mental Illness Is Mainline: How Can Clergy Help?

Last year with the release of Harper Lee’s “Go Set a Watchman,” I decided to watch the 1962 film of her first book “To Kill A Mockingbird.” Produced over 50 years ago this Pulitzer prize winner reflects real time themes of racism, violence and gender roles. But what struck me most was the stigma of mental illness. Like the Gerasene demoniac who was chained, cared for in a cemetery and lived outside city limits, Boo Radley was shunned and lived in the shadows of this story-line. No ordinary Mockingbird who mimics another birdsong, Boo sung to his own beat because he had a mental illness.
 
As a a psychotherapist in the seventies, I worked with people like Boo Radley.  Motivated by mood-managing drugs, The Community Mental Health Act (1963) mainstreamed patients from institutions and returned them to the community. On the surface this seemed like a good idea. Returning patient’s power, reuniting them with families and mingling with the public was a way to normalize mental health conditions. But it failed. Most families I worked with north of Boston didn’t want relatives back. And 24-hour Dunkin Dounut shops and CVS pharmacies didn’t want to become known as a “community center" for mental health conditions. "It’s not good for business,” they said. Sadly, systemic silence, shaming, shunning and stigma still surrounds mental illness today. Both in society and religious sanctuaries.
 
What is mental illness? Defined by governmental gold standard NIMH (National Institute for Mental Health), it’s a “functional impairment” that can range from mild to serious that “substantially interferes with or limits, one or more major life activities” (http://www.nimh.nih.gov/health/statistics/index.shtml). NAMI (National Association for Mental Illness), America’s largest grassroots mental health organization says it simpler: “A mental illness is a condition that impacts a person's thinking, feeling or mood and can effect one’s ability to relate to others and function on a daily basis” (https://www.nami.org/Learn-More/Mental-Health-Conditions). For warning signs see http://www.nami.org/Learn-More/Know-the-Warning-Signs. The causes of mental health conditions are layered and complex. Genetics, environment, brain chemistry and traumatic life events are all pieces of the puzzle. 
 
According to SAMHSA’s (Substance Abuse and Mental Health Services Administration) latest report (February, 2014), 1 in 5 Americans struggle with mental illness. That’s about 42.5 million American adults, or 18.2 percent of the total adult population in the US (http://www.newsweek.com/nearly-1-5-americans-suffer-mental-illness-each-year-230608). Because the church is embedded in society, credible statistics suggests that these same rates of mental illness cut across faith communities. According to U of L psychiatrist Robert Frierson, these are common mental health conditions clergy are likely to see:
 
 
An advocate for mental illness for 25 years, former First Lady Rosalynn Carter  summarizes the scope of the problem and calls us to take action: “People with mental problems are our neighbors. They are members of our congregations and families. If we ignore their cries for help, we will be continuing to participate in the anguish from which those cries of help come. A problem of this magnitude will not go away. Because it will not go away, and because of our spiritual commitments, we are compelled to take action.”
 
Heeding Carter’s call, United Methodist minister Susan Gregg-Schroeder founded Mental Health Ministries with a vision of producing high quality resources to reduce the stigma of mental illness in faith communities. At a conference last year (Understanding Mental Illness and Offering Hope: A Perspective for Clergy), we were given this excellent resource guide that you can download here: http://www.mentalhealthministries.net/resources/study_guide.html).  
 
According to scholarly research studies, Gregg-Schroeder was on point to provide high quality resources for clergy. A study in the sixties showed that 42 percent of those seeking help for emotional problems sought it from clergy (Gurin, et al; 1960). But more recent research (Wang, et al; 2003) reduces the rate to 23.5 by the early nineties (ibid). Though clergy still play a crucial role in the mental health delivery system, this study raises concern about religious having adequate training to recognize/treat mental health issues and little awareness of how to make referrals to professionals who do. In a growing climate of evidence based practices that are proven most effect for mental health conditions, these concerns are only heightened.
   
Now a therapist for over 25 years who’s also been a parish minster for 14, I agree with the research: Most religious leaders aren’t equipped to recognize and treat or refer mental disorders. Add to this the likelihood that over 2/3 (66%) of pastors don’t even “speak to the church in sermons or large group messages about mental illness” (http://www.christianpost.com/news/stigma-of-mental-illness-still-real-inside-the-church-lifeway-research-reveals-126832/). Still, I believe that religious leaders can do what professional therapists can’t: Pray with people, Include their needs in worship. Embrace them in a faith community. Sit with them in dark places. Listen to their stories. Stories are transformative. I felt that power when Rev. Sarah Lund’s told her story at a workshop entitled Breaking the Silence About Mental Illness at The 30th General Synod of United Church of Christ.* After sharing her testimony she turned to the attendees and asked us to tell our story, too. No longer strangers. We were one.
 
In a real sense that’s what Harper Lee’s character Scout dared to do with Boo Radley. She heard his story and walked in his shoes. She was brave enough to look him in the eye, grip his hand and walk with him down a small street in Southern Alabama. With her actions she was bearing witness to his story. It didn’t make the suffering go away. But in the same way that Jesus raised the status of a Gerasene demoniac, Scout changed the stigma on Boo Radley’s back. Telling our stories is important. Because "if I tell it anywhere right, the chances are you will recognize that in many ways it is also yours (Buechner, 11).
 
 
References
 
Buechner, F. Telling Secrets. New York, NY: Harper.
 
Carter, R. (1990). A voice for the voiceless. The church and the mentally ill; second opinion: The church’s challenge in health care. Park Ridge Center for the Study of Health, Faith and Ethics, (45-46).
 
Gurin, G., Veroff, F., Feld, S. (1960). Americans View Their Mental Health: A Nationwide Survey. New York, NY: Basic. 
 
Lee, H. (1960). To Kill A Mockingbird. New York, NY: Grand Central.
 
Lund, S. (2014). Blessed Are the Crazy. St. Louis, MO: Chalice.
 
Understanding mental illness and offering hope: A perspective for clergy. (2014, Nov 13). Norton Healthcare Church and Health Ministries.
 
Wang, P., Berglund, P., Kessler, R. (2003; April). Patterns and correlates of contacting clergy for mental disorders in the United States; 38(2): 647-673.
 

• Rev. Alan Johnson, a co-founder of the interfaith Network on Mental Illness and chair of the UCC Mental Health Network co-led Break the Silence about Mental Illness with Sarah Lund. At the 30 General Synod of the United Christ a resolution was passed “calling the people of God to justice for people with serious mental illnesses (brain disorders).” For more information  and resources for your church please visit http://mhn-ucc.blogspot.com/p/resolution_20.html

Best Practices Reporting Child Sexual Abuse

April is Child Abuse Prevention Month. Each year the President of the US and our own MA governor Charlie Baker issues a  proclamation to raise awareness and urge involvement. While awareness involves all forms of abuse (http://www.mass.gov/eohhs/gov/departments/dcf/child-abuse-neglect/warning-signs.html). This proclamation focuses on all forms of abuse. This little fact sheet focuses on sexual abuse. Likely you know a child that’s been sexually abused. Experts estimate that 1 in 10 children are sexually abused before their 18th birthday.This means that in any classroom, neighborhood, and church there are children who are silently bearing the burden of their abuse. Here’s more eyeopening statistics: 

• More than four children die every day as a result of child abuse.
• Approximately 70% of children that die from abuse are under the age of 4. 
• More than 90% of child sexual abuse victims know their perpetrator.  


Child abuse isn’t just a sin. It’s a crime. All 50 states have mandatory reporting laws. Clergy and and child workers are front line responders and mandated to report. But most don’t. There’s a fear factor. Some say they don’t know the signs, how to make a report or fear the consequences. But the consequences of not reporting are much more grave. Children who carry secrets they fear won't be believed suffer long term psychological, emotional, social, and physical problems into adulthood. Child victims become adult survivors. Healing is a long journey home.

Realizing the definition for child sexual abuse is a start toward prevention: It not only involves physical contact and penetration. It's any sexual act between an adult and a minor, or between two minors, when one exerts power over the other; forcing, coercing or persuading a child to engage in any type of sexual act; non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner by phone or Internet http://www.D2L.org/LearnTheFacts.

Reporting doesn’t require proof. In most states reasonable suspicion is necessary to make a good faith report. “Reasonable suspicion means you have witnessed physical or behavioral signs of maltreatment, either in the child or parent/caregiver, or both. OR, you have received a disclosure from a child about abuse, neglect, or boundary violations towards them” (www.d2l.org). Be prepared to give the child’s name, address and age, parent’s name and address and the nature of the abuse. Even if there’s not enough evidence to convict, reporting creates a paper trail that can lead to future action. You do not need to provide your name unless you are a mandated reporter and required to do so by the law in your state; however in all cases mandated reporters contact information is is confidential and protected by law. Learn your state's laws (see https://www.childwelfare.gov/pubPDFs/clergymandated.pdf). For those who live in MA as I do click on this informational brochure for more: http://www.mass.gov/eohhs/docs/dcf/can-mandated-reporters-guide.pdf.

Darkness to Light, an organization committed to educating the public about child sexual abuse reports that "90% p of the time, the child is telling the truth" when he/she discloses. They offer best practices when a chil discloses: 

1. Say, I believe you and it's not your fault. 

DO ask open ended questions: "Then what happened?"
DON'T express anger or disbelief.

2. Conduct a "minimal fact" interview.

DO determine what, where, when and by whom, if possible.
DON'T ask leading questions and probe for details.

3. Report immediately.

DO tell law enforcement/child protective services.
DON'T attempt further investigation. 
DON'T promise not to tall anyone.

If the child does not readily supply this information, do not continue to question or investigate. It could interfere later with the investigation.

For further information see: https://www.D2L.org (How to Report Child Abuse)

Summarizing, April is Child Abuse Awareness Month. Reflecting on the cross, it wasn’t just a handful of enemies responsible for Christ’s death. But the silence of his friends. Silence, even when well-intended enables a culture of abuse and “in the end we will remember not the words of our enemies but the silence of our friends (Martin Luther King, Jr.). Please. If you see something, say something.

Dr. Rev. Beverly Blaisdell-Weinhold

April 13, 2016

Coping With Ambiguous Loss: Resiliency Not Recovery

Lent in the Christian calendar is a reminder of loss. The Jews lost hope for a political king. Jesus’ disciples lost their leader. And Jesus lost his life. Loss is inevitable in life. As Queen Elizabeth II reminded "Grief is the price we pay for love” (2000, 5). If we attempted to avoid loss by never forming loving relationships with people, places and even pets what would life be like? The natural response to loss is grief. Rabbi Earl Grollman eloquently defines grief as “love not wanting to let go.” It tears us up to lose what we love. Grieving our losses covers a broad spectrum: the death of a loved one, miscarrying a baby, divorcing a spouse, losing a job, moving from home and so on. These are a few examples with one thing in common: The loss is clearly defined and is most often marked by rituals or rites. Though recovery is recursive with tidal waves of grief, the trajectory is toward closure. Which is why Kubler-Ross (1970) described recovery in five stages: denial, anger, bargaining, depression and acceptance.

The defined loss spoken of above is one category. But there’s a second category called ambiguous loss. It’s not as neatly defined. Pauline Boss a psychologist who grew up in an immigrant community coined the term in 1999. People experience ambiguous loss in two ways: 1) when a loved one is physically missing but emotionally present. Catastrophic examples are bodies missing due to war, terrorism, genocide, natural disasters, or kidnappings. Also absent parents due to divorce, adoption, and immigration. 2) refers to a person’s physical presence while emotionally or cognitively absent. Examples are mental illnesses, dementias, traumatic brain injury, depression and addiction. Translated into contemporary terms, the term also applies to deployed partners in military, estranged adult children from families, spouses living together having affairs, children incested by family members and transitions in gender identity.  

Ambiguous loss is not only messy to define but tougher to cope with. Unlike defined loss it has no closure. There’s no linear stages (Kubler-Ross,1969), non-linear stages (Stroebe and Stroebe,1993) nor tasks (Worden, 2002) toward recovery. And unlike the customs and rituals that accompany defined loss like funerals (Christian faith), shemiras (Jewish faith) and Janazah (Islam), there aren’t any. Since there’s no culturally acceptable ways to publicly grieve, people who want to care don’t know how to respond in compassionate ways. There are no cards, condolences, casseroles or even comforting words. Most ignore what’s happened or deny it altogether. It feels too uncomfortable to face. Some compelled to speak, seldom know what to say: should we encourage hope that the loss will resolve? Or do we advise acceptance that the person is gone and the relationship is changed forever? 

With no cultural norms to respond and little clinical research to inform the wider community, there’s a lack of information on so many levels. Often ambiguous grief morphs into Post Traumatic Stress Disorder or PTSD (https://www.mnadopt.org/wp-content/uploads/2014/03/Understanding-Ambiguous-Loss.pdf). The chronic ambiguity of the loss freezes the grief process, prevents self-insight, blocks decision-making and paralyzes moving forward. The griever feels helpless, hapless and hopeless. In this condition a sufferers  construct their own reality surrounding the loss and are anxious, depressed and stuck. The residue of this dynamic begins to effect all relationships. Summarizing Boss says that “People hunger for certainty…[therefore] of all the losses experienced in relationships ambiguous loss is the most devastating because it remains unclear and indeterminate.” (1999, 6). 

No. The way forward with ambiguous loss is not recovery. It’s resiliency. Based on Boss’ extensive experience working with over 4000 suffering families from New York to Bosnia-Herzegovina, best practices suggest not “going for closure,” but rather building strength for acceptance and tolerance for ambiguity (see http://www.amazon.com/Loss-Trauma-Resilience-Therapeutic-Ambiguous/dp/0393704491). For starters this requires resisting social pressure “to get over it” and garnering support of ‘family’ to provide safety and support. Here, family is loosely defined. It includes intimate relationships with people “whom we can count on for emotional closeness” and basically “be there” to normalize our experience (1990, 4). This family may or may not be blood relatives. Instead of the people we grew up with, it’s the community we choose in adulthood. This family of choice is critical to coping with ambiguous loss. And intentionally cultivating this family is one of the strongest predictors of resilience in the face of loss, crisis and trauma (Bonanno (2004), Boss, 2006). Below are more suggestions for coping with ambiguous loss for both grievers and caregivers:

For Grievers:

Educate yourself. Learn what you can about ambiguous loss and see how it fits for you: http://www.ambiguousloss.com/four_questions.php

Give voice to ambiguity. Put a name to your feelings of ambiguous loss. Acknowledge without apology how difficult It is to live with it. If you have no one to talk to who feels safe, journal about it, find a grief group or go to a 12 step program so you can speak freely and confidentially.

Identify and grieve what’s lost and celebrate what still is. Create a “loss box.” In her work with adopted adolescents, Debbie Riley (https://www.mnadopt.org/wp-content/uploads/2014/03/Understanding-Ambiguous-Loss.pdf) suggests designating a box where you place items representing what you’ve lost. Remember the good that people, places, pets have given without denying disappointments. This provides a ritual to process grief and transform it to gratitude.

Learn to live with ambiguity. Resist black & white. Steer clear of trying to fix, control and change the problem. Practice dual thinking or both/and thinking. Shift your paradigm for seeing life in terms of right/wrong; black/right. Realize that life is lived in a paradox of truth tensions. Finding meaning means learning to walk a tight rope toward accepting ourselves/others as flawed while at the same time setting boundaries and holding people accountable. Avoid self pity and seeing yourself as alone, recognizing that many people walk with you in the same spot. 

Rediscover agency & reframe family. Rather living with regret for what’s gone or trying to recapture what was by recycling old dynamics, recover personal power by making new decisions and exploring new relationships. In Boss’ words do “small good works (http://www.preventionworkscc.org/Email/FPCAmbiguous%20Loss%20-%20Finding%20Resiliency%20Despite%20Unclear%20Loss%2012-08.pdf),” reframe roles in your relationships, accept people as they are rather than how we want them to be and create new holiday/family rituals even if you’re single. Reframe ‘who am I’ in light of your loss. 

Cultivate spirituality. Living with this kind of loss often impacts our faith. “How could a good God let this injustice happen?” Hence our alienation is not just with people, but the Holy. Tell God straight out how angry, hurt, alone and sad you are. Simply say ‘help.’ Reconnect not just with yourself and others, but with God. Be defined. Stay connected. Just show up.


For Care-Givers:

Offer support. Rather than trying to say the ‘right thing’ just listen. Be physically/emotionally present. Avoid pat answers to bring closure like: “Don’t worry. This will all work out.” Instead be open-ended: “Just take it a day at a time” or “one step at a time,” and “I’ll walk with you in this.”

Normalize the loss. Avoid playing amateur psychologist and giving advice. Invite grievers over for a cup of coffee, for dinner, to watch TV or just for a shopping trip. Include them in your family.

Allow another to go at their own speed & in their own way. Resist the pull to push a griever into a position or perspective of their loss Avoid pressuring people to “get on with life” or put a lid on their loss. Let them grieve at their own pace. Sit with the ambiguity yourself rather than rushing to judgement and imposing your way on another’s process. 

Invite another to your church, synagogue or mosque, etc. Or go with them to theirs. Suggest a 12 step program if appropriate like Adult Children of Alcoholics (www.adultchildren.org) or Codependents Anonymous (www.coda.org). Go with them.

Calmly suggest that a mental health professional might help. All of us encounter periods in life when we feel lost and overwhelmed. We feel stuck and at our wits end. We can’t see the next best step. It’s normal and natural to reach out to an experienced professional. Doing so suggests emotional maturity not personal weakness. Suggest to look for a qualified and experienced professional in your area by going to this website: (www.psychologytoday.com)  and putting in your zip code. Or ask your medical doctor/spiritual leader for a recommendation. 

Take care of yourself and don’t promise what you can’t deliver. Follow-through is important for the sake of trust. So be clear about what you can/cannot do. If you don’t, you’ll not only re disappoint an already hurting person but burn yourself out. 

Summarizing, there are two types of loss: defined loss and ambiguous loss. In the case of defined loss a person, place or pet is gone for good. Ambiguous loss isn’t as neat. Instead its a tension between two truths: A person is either physically present but emotionally absent, or emotionally present but physically absent. Since ambiguous loss is not clear cut, recovery isn’t the goal. Instead the journey toward healing is resiliency through learning to tolerate ambiguity, accept the paradox of people’s presence/absence, and reframing a family of choice. These twilight themes of loss remind us of Lent. Jesus was a refugee with a Divine Parent who was both present and absent in his Passion on the cross. “My God, My God why have you forsaken me?” is Jesus’ cry of ambiguous loss. It's the soul struggle that faces us all. And with faith it leads us from the shadows of Lent into the spring of Easter. Not a closure, but a transformation. Not a coffin, but a ressurection. For “only people who are capable of loving strongly can suffer great sorrow. But the same necessity of loving strongly serves to counteract their grief and heal them” (Leo Tolstoy). 

References

Bonnano, G. (2004). Loss, trauma and human resilience: Have we underestimated the ability to thrive after extremely adverse events? American Psychologist. (59)1, 20-28.

Boss, P. (1999). Ambiguous loss. Learning to live with unresolved grief. Cambridge, MA: Harvard University.

Boss, P. (2006). Loss, Trauma and Resilience. New York: W. W. Norton.

Boss, P. (2007). Ambiguous loss theory: Challenges for scholars and practitioners. Family Relations. (56), 105-111. 

Boss, P. (2013). Resilience as tolerance for ambiguity. In D. S. Becvar (Ed.), Handbook of family resilience, (285-297).

Doka, K. J. (2002). Introduction. In K. J. Doka (Ed.), Disenfranchised grief: Recognizing hidden sorrow. Lexington, MA: Lexington Books.

Grollman, E. (2000). Living with loss, healing and hope: A Jewish perspective.  Boston, MA: Beacon.

Kubler-Ross, E. (1970). On death and dying. New York: Collier Books/Macmillan.

Queen Elizabeth, II. (Sept 21,2001). Grief is the price of love, says the queen. The Telegraph. D. Sapsted, P. Foster and G.Jones in New York.

Stroebe, M., Stroebe, W., & Hansson, R. (1993). Handbook of Bereavement. Cambridge, MA:
University.

Worden, W. (2002). Grief counseling and grief therapy (3rd ed). New York, NY: Springer.

SPOTLIGHT on Systemic Silence Surrounding Child Abuse

After seeing “Spotlight” about the Boston Globe investigation of child abuse coverups in the Catholic Church, I can’t stop thinking about how far secrecy goes in institutions. Mark Ruffalo who played Mike Rendezza in the movie won a SAG (Screen Actor’s Guild) award. In his acceptance speech he cites the Catholic coverup is “one of the most horrific things our culture has allowed to happen. http://deadline.com/2016/01/sag-awards-spotlight-acceptance-speech-mark-ruffalo-michael-keaton-video-1201693799/ .” He doesn’t just blame priests. But shines the light on bystanders who saw something but said nothing. It was this systemic silence that prompted Attorney Mitchell Garabedian’s point in the movie: “It takes a village to raise a child. It takes a village to abuse them.” The lingering questions left for me as a church-going clinician is: How can cultures called to protect children allow abuse? What’s the impact on children who become adult survivors? What steps can we take to respond faithfully? Big questions for a small article. We can only start the conversation.

Systemic silence is a collective phenomenon that turns a blind eye to bad behavior. People sweep it under the rug, act like it didn’t happen and hope it will go away. In the case of a crime, victims are seldom believed, offenders aren’t held accountable and faith communities can’t heal. Extreme examples of systemic silence include revisionist history of the Holocaust, abuse of Iraqi prisoners by American soldiers at Abu Ghraib and the support of Sandusky by those who saw him rape boys. Most of us who keep quiet (and we all do) aren’t evil. Our intent isn't harm to innocents. Often its conflicting loyalties between people we love and values we hold dear. We can't believe that ‘such good people can do such bad things.’ There’s little scholarly research or theological reflection on systemic silence. But it is in the Bible. Joseph’s brothers colluded in silence for decades about his child abuse. Not sexual, it was physical. They ditched him in a pit and left him for dead. Then he was trafficked into slavery. 

Clinician Sandra Butler coined this concept in her groundbreaking book called Conspiracy of Silence: The Trauma of Incest (1979). Rev. Dr. Marie Fortune from the Faith Institute in Seattle then imported the idea from families of origin to families of faith (Sexual Violence: The Unmentionable Sin). Now,  Boz Tchividjian, Billy Graham’s grandson and founder of GRACE (Godly Response to Abuse in the Christian Environment), has become the herald to evangelicalism (http://www.netgrace.org/resources/2015/4/9/where-are-the-voices-the-continued-culture-of-silence-and-protection-in-american-evangelicalism). It’s Tchividijan who tackles my first question (http://www.netgrace.org/resources/2015/4/9/walls-of-silence-protecting-the-institution-over-the-individual): How can cultures called to protect children allow abuse? Pointing to church leaders, he suggests three reasons: directing members not to speak under the guise of gossip,  refusing to report to law authorities and downsizing the offense and passing perpetrators on to another parish. In a follow-up story with "Spotlight's" investigative team (New Yorker, 2015), one reporter gives another reason: "If the crimes of the priest were mentioned, they were often referred to as ‘sins,’ for which the priest had repented and been forgiven. With no sophisticated understanding at a time when there should have been that these were A) criminal acts and B) criminal acts of a type that recur again and again (http://www.newyorker.com/culture/sarah-larson/spotlight-and-its-revelations).”

Seeing abuse as a sin to be forgiven instead of a crime to be dealt with is likely why offenders aren’t always held accountable and survivors are seldom believed. That's certainly what happened initially in the Sandusky story. While consequences to Penn State and former coach Joe Paterno dominated the media, there was little said about the impact on victims. The same can be said for the Catholic crisis. “There was no appreciation whatsoever of the impact on a child’s life or development,” Rendezza says. “Zero,” reporter Sacha Pfeiffer agreed. “And I think that’s one thing that’s still unclear. Does the Church get it? Do they get how it totally affects you the rest of your life (http://www.newyorker.com/culture/sarah-larson/spotlight-and-its-revelations)?” If we're honest most of us don't. But you don’t have to be a veteran, a refugee or a rape victim to experience trauma. All of us can and many do. Crediable research shows that one in five Americans is sexually molested as a child; one in four was beaten by a parent and one of the three couples engages in physical violence and one in eight children witness their mother being hit (Felitti, et all; ACE Study).

Recovery from trauma is not an event. Its a long journey home. A journey with life-altering effects. Drawing on thirty years of experience, Dr. Bessel Van Der Kolk, one of the world’s foremost experts on this subject sums up its impact: “Most rape victims, combat soldiers and children who have been molested become so upset when they think about what they experienced that they try to push it out of their minds, [and] act like nothing happened (The Body Keeps the Score, Prologue, 1).” As you can imagine it takes tremendous energy to move on while carrying a memories of terror that you’re too ashamed to talk about. Feeling small and weak some compensate by being strong and  successful to deflect their shame and downplay their chronic loneliness. Numbing feelings for a lifetime to survive, we feel disembodied, displaced and often spritually homeless. To Van Der Kolk's research," trauma reshapes both body and brain, compromising sufferers’ capacities for pleasure, relationships, self-control and trust (ibid, jacket). New Testament Professor and adult survivor Andrew Schmutzer's names being abused as "Majestically Broken:"

Collector-of-Fragments, we are broken now.  
Fragmented are simple expectations.  
Fragmented are life-giving hopes. 
Fragmented are ligaments of faith. 

How good are you at:  
Finding, Cleaning,  
Mending pieces of lives? 
The dismembered, displaced and disoriented need to know 

Facing what the Center for Disease Control calls a "hidden epidemic" in this country how can faith communities respond faithfully? For starters, the definition for child abuse is broader than you might think. It not only involves physical contact and penetration. It's any sexual act between an adult and a minor, or between two minors, when one exerts power over the other; forcing, coercing or persuading a child to engage in any type of sexual act; non-contact acts such as exhibitionism, exposure to pornography, voyeurism, and communicating in a sexual manner by phone or Internet http://www.D2L.org/LearnTheFacts. Because in the words of the then Globe editor Marty Baron "We’re going after the system,” its important to begin by raising awareness among leaders and educating and equiping whole congregations:



  • Arrange training for clergy and staff by a qualified clinician (http://www.beverlyweinhold.org) to learn how respond to a victim’s disclosures, offer informed pastoral care and make appropriate referrals to community resources. 


  • April is Child Abuse Awareness Month. Preach a sermon on it, light a candle and pray for victims in a worship service. And invite a Women's Center or Shelter to speak in a 'spotlight' moment during the service and have conversation a coffee after church.

  • Be proactive and make a plan based on best practices in case of an allegation against a clergyperson, staff, volunteer or congregant in your faith community.(http://www.gundersenhealth.org/upload/docs/NCPTC/Jacobs-Hope/Jacobs-Hope-vol2-issue1.pdf).

Summarizing, a faithful response to child sexual abuse that brings restorative justice includes holding perpetrators accountable, believing and supporting victims and including congregations with appropriate levels of disclosure rather than imposing a gag order. Healing involves the whole community to insure that the same cycle won't recycle again. Prevention requires raising awareness, breaking silence and equipping the system and making a plan. Child abuse is an adult problem. If we see something we must be brave enough to say something. Where were you,” Robinson asks Jim Sullivan in “Spotlight” the movie. “I don’t know Robbie. We all knew something was going on. Where were you?”


References

ACE Study-Prevalence-Adverse Child Experiences, http://www.cdc.gov/needphp/aceprevalence.htm.

Butler, S. (1979). Conspiracy of Silence: The trauma of incest. Sierra Nevada, CA: Volcano.

Felletti, et al. “Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study.” American Journal of Preventive Medicine 14, no 4 (1998): 245-58.

Fortune, M. (1983). Sexual Violence: The unmentionable sin. Cleveland, OH: Pilgrim.

Larson, S. “Spotlight” and its revelations.” New Yorker Magazine (Dec 8,2015). 

Pagen-Faust, B., et al and McCarthy, T. Spotlight. (2015). US: Open Road Films.

Schumtzer, A. Ed. (2011). The Long Journey Home. Eugene, Or: Wipf & Stock. 

Schumutzer, A. “We Are Majestically Broken.” The Long Journey Home. (2011): Appendix.
 
Van Der Kolk, B. (2014). The Body Keeps the Score: Brain, mind and body in the healing of 
trauma. NY: Penquin.
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