• Help Me Understand Your Anxiety Disorder: Spiritual Practices and Other Means of Support

    This is the sixth post in a series that I am writing to help people in the church better understand mental health, and particularly anxiety disorders. Click to read the firstsecondthirdfourth, and fifth posts.

    After all I’ve shared in this series, you might be asking: if you have an anxiety disorder, and you are a Christian, how do you know if what you’re experiencing is sinful worry and something to repent of, or a symptom of your anxiety disorder? I understand wanting an answer to that question. It’s one that I’ve asked many times over the past few years and have grappled with in counseling with my Christian counselor. I don’t want to be complacent; I want to kill sin in my life at every turn. I’m also a bit of a perfectionist, and a rule-follower, and really want the security of knowing that I am doing everything correctly.

    But at the end of the day, the answer is: you can’t perfectly untangle it. If you have placed your faith in Christ alone for salvation, you are in Christ, and you have the Holy Spirit living inside of you. The Spirit will convict you of sin, and as you find sinful worry and fear in your life, you turn to Christ, repent, and remind yourself again that in him you are righteous. But you will likely never be able to perfectly delineate exactly whether every thought you have is springing into your mind from a misplaced reliance on self and lack of faith in God versus being driven into your mind by your disregulated nervous system. 

    In many cases, believers with anxiety disorders are extremely vigilant about rooting out sinful worry, because they are more aware of their tendencies and they have done a lot of work to understand and confront their fears and worries with truth. I know this is true for me. In fact, while my anxiety disorder has been a source of great suffering for me, it has also been one of the greatest sources of my sanctification. 

    I truly believe that God could heal me at any moment, and I have begged him to—but at the same time, when I see the good fruit that has come from my suffering, there is a part of me that has great peace about continuing to bear it. I hate having an anxiety disorder—and yet, how can I hate the thing that has made me the most like Christ?

    If you’re suffering from an anxiety disorder and still feeling crushed under the belief that it is solely due to your own sin, or if you are someone who persists in believing that the root of all anxiety disorders is sin, I would simply say this: I think a good rule of thumb is that sin does not make you more Christ-like. If something is making a person more like Christ, it’s very unlikely that it’s caused by unrepentant sin. We are all sinners, but if you think of someone experiencing an anxiety disorder as more of a sinner than a sufferer, I plead with you to reconsider.

    If you are a believer with an anxiety disorder, you surrender yourself to God and you do the work that you can, as best as you can. There are lots of things that will affect the severity and frequency of the disregulation of your nervous system and the physical symptoms that you experience. For example, sleep has an enormous effect on the body’s ability to regulate itself. So, you do what you can to get good sleep—but if you’re a new parent, or have to work long hours to make ends meet, or any of a host of other reasons why you might have disrupted, too little, or low-quality sleep—you may experience more symptoms. You are not failing if this happens—you are simply experiencing the reality of life in this broken world.

    If you are a believer and you think you may suffer from an anxiety disorder, I highly, HIGHLY recommend that you see a counselor. The primary counselor I see is a Christian counselor, meaning that she incorporates our mutual convictions about God, sin, and the gospel into my therapy, but is also educated and knowledgeable about various methods of evidence-based therapy that are not solely based on the Biblical text. This is not true of all counselors who are Christian. You should RUN, not walk, away from any counselor who does not acknowledge the basic realities of how mental illnesses, including anxiety disorders, work. If you go to a counselor and it’s clear that they believe anxiety is only sinful, they are not educated about the role of physiology in anxiety disorders, and deny or only pay lip service to the common grace God has given us in medicine, medication, and psychological research, their approach is not Biblical, but rather Gnostic. If this is their approach, they likely are not even qualified to assess whether your anxiety is clinical in nature. Please be wary, because there are many purported counselors who are Christians and take this sadly misinformed approach.

    I have also found good support in working with a counselor who is trained in Cognitive Behavioral Therapy. Especially if you are prone to panic attacks, this approach can be extremely helpful.

    This is how I have learned to wisely manage my own anxiety disorder. I don’t simply throw up my hands and say there’s nothing that I can do, but I also accept that God has providentially allowed this limitation, this suffering, this particular form of brokenness in our sin-crushed world, into my life, and I cannot ignore it, or pretend it doesn’t exist, or make it go away unless and until He wills it. I accept that there is grace for me in my imperfection. He knows my frame; he remembers that I am dust.

    Fellow sufferer, he knows your frame, and he remembers that you are dust. We are not simply disembodied brains floating around in the world—we are embodied souls. When God created us, he gave us our bodies—the ones that betray us, yes, but also the one that is an integral part of who we are, that is part of our whole humanity, that will one day be redeemed and glorified.

    I have only scratched the surface in this series, and there is so much more that can be said about issues of mental health and the church. I am passionate about the church understanding these issues. If you have questions, please let me know. If you have an anxiety disorder, I hope this is encouraging to you. If you do not, I hope this is educational. My fervent prayer is that we, the Church, would not inadvertently wound those who are suffering from anxiety disorders or other mental health problems due to misinformation or ignorance about these issues.

  • Help Me Understand Your Anxiety Disorder: Medication

    This is the fifth post in a series that I am writing to help people in the church better understand mental health, and particularly anxiety disorders. Click to read the first, second, third, and fourth posts.

    As I’ve explained, anxiety disorders at their core are a physiological disorder of the nervous system. This is one of the reasons that medication can be helpful if you have an anxiety disorder. Medication can decrease the intensity and frequency of free-floating physical feelings of worry and fear. It can help your parasympathetic nervous system activate after your sympathetic nervous system has activated, instead of letting your sympathetic nervous system continue dumping adrenaline into your system with no countervailing force.

    Not everyone’s symptoms will respond to medication in the same way. Note: I am not saying that if your symptoms do not respond to medication that there is no physiological component. In almost all cases you cannot definitively ascertain the exact nature of the imbalance between the two halves of your nervous system. By that, I mean that in the vast majority of cases there are no tests that can show you the exact chemical or other physiological imbalance at work because the brain and body are unimaginably complex. Managing mental health issues with medication is therefore often both a science and an art.

    I find that medication for mental health issues is the issue that Christians struggle with the most when it comes to mental health. In many cases, we have been trained to resist medication in this area unless we think that we know we need it, and to be skeptical of other people’s use of it. But we, of all people, should most appreciate the intricate and sometimes mysterious ways in which our bodies, minds, and spirits are knit together.

    Taking medication for your anxiety disorder does not, in my experience, mean that you will no longer experience physical feelings of worry and fear. Rather, it means that you will experience them when you are actually feeling (mentally and emotionally) worried and afraid. The goal is not to be numb, or to medicate away your problems, or to simply take a pill and pretend that there are no worries and that you don’t have to lean on Christ. In the church, I have heard people who take medication for anxiety characterized in all of these ways. If this is how you speak about people suffering from anxiety, please stop. Although the idea that you can take medication and therefore avoid taking your fears and worries to Christ often gets bandied about among some Christians, I have never met one person with an anxiety disorder who has used medication to simply mute their fear or worry and who does not still have to lean on Christ with all that they have. I’m honestly not sure that it’s even possible for someone to do that, and I think it’s mostly a myth that is not grounded in reality.

    In my experience, when medication diminishes the severity and frequency of free-floating physical sensations of worry and fear, things like prayer, reciting God’s promises, and reminding yourself of God’s sovereignty over all things are actually able to be effective. If your body is gratuitously dumping adrenaline into your system without trigger or cause, you can do these things as much as you want, but you will still feel physically anxious, often to a debilitating degree, because that is what happens to your body when it is flooded with adrenaline, especially for extended periods of time.

    In my experience, being on medication doesn’t mean that you have no feelings or are abnormally calm. It just brings your body more in line with your brain and lets you use truth (including Biblical truth) in a way that actually impacts your body. Medication that acts in the long term can stabilize your nervous system to allow this; medication that acts in the short term can arrest a free-floating anxiety or panic response and keep your nervous system from continuing down a path of disregulation without cause.

    *Please note: I am not a medical or counseling professional and this series is not intended to be any sort of substitute for any counseling, medical treatment, or other care you or anyone else has received for mental health issues. I am simply sharing my own experience for general educational purposes.*

  • Help Me Understand Your Anxiety Disorder: What It’s Like

    This is the fourth post in a series that I am writing to help people in the church better understand mental health, and particularly anxiety disorders. Click to read the first, second, and third posts.

    If you don’t have an anxiety disorder, it can be hard to imagine what it’s like. Hopefully the discussion in the last post helped you to start imagining what it might be like, since we all have experienced a fight-or-flight response at one time or another. I’m going to attempt to describe some of what my own experience of having an anxiety disorder has been like.

    For me, my anxiety disorder generally manifests as physical feelings, including a sick feeling in my stomach and my heart skipping a beat (or a lot of beats, if it’s a full-blown panic attack). I am in most cases feeling mentally and emotionally calm and unworried, and not thinking about or experiencing anything that is anxiety-provoking. But, I “feel” anxious because my body is experiencing all of the physical feelings that I experience when I am actually afraid or worrying (because they literally are the same physical feelings I would have if I was actually worrying about something or in a situation that would trigger fear).

    My husband often explains my anxiety disorder to people this way: Imagine you are sitting in a cozy room, sipping tea by a roaring fireplace, and suddenly, out of nowhere, your body is reacting as though someone just threw a brick through the nearby plate glass window. Everything is calm—both your environment and your emotions—but your body’s fight-or-flight reaction has been triggered.

    This is why telling someone who has an anxiety disorder to “not worry” is so unhelpful—in many, if not most cases, they are not actually worrying in any meaningful sense. Their thoughts and emotions are not what is causing them to feel anxious—instead, it is their nervous system run amok. Their body has been hijacked by physical sensations that are unaccompanied by any mental or emotional trigger. This is what is meant when someone says that there is a chemical or physical component to anxiety.

    This is not to say, however, that someone who has an anxiety disorder does not experience the emotions of worry or fear. As I said above, we all experience mental and emotional worry and fear, and having an anxiety disorder does not make you immune to this. In fact, if you have an anxiety disorder, and particularly if it is undiagnosed, the fact that you are experiencing physical sensations of fear or worry will cause your brain to look for an explanation for why your body is having the physical response it is having. Your brain does not think it makes sense for you to be physically feeling worried or afraid if there is no mental or emotional reason for it—and your brain is right. This is why your experience is properly described as “disordered”—your body’s fear response is not the result of an orderly chain of events with an actual emotional or mental trigger of fear or worry.

    Nevertheless, if your brain goes looking for the reason that you are physically feeling worried or afraid, it will continue looking until it finds something–and we certainly all have things that we COULD be worrying about or afraid of. So, if you have an anxiety disorder, and you are experiencing physical symptoms, your brain is constantly trying to find the reason for those symptoms. It may, for example, latch onto a problem at work to make sense of why the body is so anxious. However, if you have an anxiety disorder, it is likely that the anxiety that you are experiencing about the work problem (which your brain has seized on to make sense of the nervous system response that you are having) feels (physically, mentally, and emotionally) way out of proportion to the problem at hand. Because the origin of this worry is a physiological response, even if you can pray for peace, rationally speak truth to yourself, and calm yourself mentally and emotionally, it is likely the physical feelings will not lessen and will remain for some time. Because the embodied feeling of worry or fear has a physiological cause, in many cases, resolving any emotional, mental, or spiritual distress may not alleviate those feelings. In the most simplistic terms, that is what it means to live with an anxiety disorder.

    *Please note: I am not a medical or counseling professional and this series is not intended to be any sort of substitute for any counseling, medical treatment, or other care you or anyone else has received for mental health issues. I am simply sharing my own experience for general educational purposes.*

  • Help Me Understand Your Anxiety Disorder: Fear or Worry vs. Clinical Anxiety

    This is the third post in a series that I am writing to help people in the church better understand mental health, and particularly anxiety disorders. Click here to read the first post, and here to read the second post.

    At the outset, I want to make clear that as I go through the differences between fear or worry versus clinical anxiety below, these are based primarily on my own personal experiences. Therefore, please don’t understand me to be speaking for every person who has an anxiety disorder, because these disorders can manifest in a variety of ways, and it is not my intent here to discount or negate someone else’s experience. I simply want to offer my experiences as one means to provide understanding and education about anxiety disorders.

    People who have anxiety disorders, like every other human being, experience worry and fear. If you are a Christian, you believe that a person also experiences sinful worry and fear. However, speaking from my own experience, the primary indicator that you have an anxiety disorder is NOT simply that you worry a lot.

    I’m going to say that again.

    The primary indicator that you have an anxiety disorder is NOT simply that you worry a lot.

    Let me explain.

    Think about a time that you were worried–say, about a big test, or a review at work, or because you were about to see someone with whom you have a strained relationship. Now, think about how your body felt in that moment. If you have to, close your eyes and recall it. How did you know that you were worried? Did your stomach feel slightly sick? Was your heart beating a little faster than normal? Did you feel lightheaded? Did you feel slightly shaky? Were you sweating? Did your brain feel a bit fuzzy or easily distracted? You may not have felt all or any of these specific things, but if you pay close attention, there were physiological changes that caused physical sensations in your body that you associate with being worried.

    Okay, similar exercise. Think about a time that you felt afraid, say, when your home alarm went off in the middle of the night, or you almost got into a car wreck, or you were walking alone on a street at night and thought you heard someone following you. How did your body feel in that moment? Again, if you have to, close your eyes and recall it. Did you feel your heart beating in your chest? Did you feel blood rushing in your ears? Did you feel your face flush and get warm? Did your heartbeat quicken? Did you suddenly feel colder or warmer? Again, you may not have felt any or all of these specific things, but because you are an embodied being, your experience of feeling fear included some number of physiological changes caused either by having an emotional experience of fear or an instinctual response to a threatening situation. These changes, in turn, caused physical symptoms that you associate with being afraid.

    Still with me? Okay. If you have an anxiety disorder, one of the things that happens is that your body experiences the physical sensations that you associate with worry or fear when there is no external stimulus that is causing you worry or fear and you are not actually emotionally experiencing worry or fear. One more time, just to emphasize: if you have an anxiety disorder, one of the things that happens is that your body experiences the physical sensations that you associate with worry or fear when there is no external stimulus that is causing you worry or fear and you are not actually emotionally experiencing worry or fear.

    I find that many people don’t even realize that the body plays a role in their experience of emotions until you point it out to them. In fact, at first, many people will say that they don’t experience any physical symptoms or sensations when they are experiencing an emotion. We tend to have this idea that emotions are something that is purely a matter of the mind, or maybe the mind and the heart. We often are so tuned out from our bodies that we don’t even realize the role that they are playing in our experience of the world. Unfortunately, there is a particularly significant lack of understanding in the church about the ways in which the brain and body play a role in causing and experiencing emotions like fear and worry.

    In extremely simplistic terms, your autonomic nervous system has two divisions: the sympathetic nervous system (fight-or-flight) and the parasympathetic nervous system (rest and digest). Typically, the two balance each other out. When your sympathetic nervous system is activated and your body pumps out adrenaline and other chemicals which have corresponding physical symptoms, your parasympathetic nervous system then kicks in to calm the body back down when this function is no longer needed.

    However, if you have an anxiety disorder, your parasympathetic nervous system does not function properly and does not kick in to regulate your sympathetic nervous system as it should. Therefore, your body is unable to properly regulate your sympathetic nervous system response, and it can spiral out of control, because there is no counterbalancing system kicking into effect. In this sense, the term “mental illness” doesn’t really capture the reality of suffering from an anxiety disorder, because what in actuality is occurring is a physiological malfunction that can then have emotional and mental consequences.

    Next time, I’ll talk more about what it’s like to have an anxiety disorder and some helpful and unhelpful ways to respond.

    *Please note: I am not a medical or counseling professional and this series is not intended to be any sort of substitute for any counseling, medical treatment, or other care that you or anyone else has received for mental health issues. I am simply sharing my own experience for general educational purposes.*

  • Help Me Understand Your Anxiety Disorder: Terminology

    This is the second post in a series that I am writing to help people in the church better understand mental health, and particularly anxiety disorders. To read the first post in the series, click here.

    There is a significant amount of confusion and misinformation about anxiety disorders in the world at large, and especially in the church. Part of the confusion stems from the terminology. “Anxiety” is not by definition a clinical term. So a person can say that they are anxious, or struggling with anxiety, and simply mean that they are worrying about something.

    Indisputably, the Bible has much to say about worry. Take, for example, Christ’s words in the Sermon on the Mount:

    “Therefore I tell you: Don’t worry about your life, what you will eat or what you will drink; or about your body, what you will wear. Isn’t life more than food and the body more than clothing? Consider the birds of the sky: They don’t sow or reap or gather into barns, yet your heavenly Father feeds them. Aren’t you worth more than they? Can any of you add one moment to his life span by worrying? And why do you worry about clothes? Observe how the wildflowers of the field grow: They don’t labor or spin thread. Yet I tell you that not even Solomon in all his splendor was adorned like one of these. If that’s how God clothes the grass of the field, which is here today and thrown into the furnace tomorrow, won’t he do much more for you—you of little faith? So don’t worry, saying, ‘What will we eat?’ or ‘What will we drink?’ or ‘What will we wear?’ For the Gentiles eagerly seek all these things, and your heavenly Father knows that you need them. But seek first the kingdom of God and his righteousness, and all these things will be provided for you. Therefore don’t worry about tomorrow, because tomorrow will worry about itself. Each day has enough trouble of its own.”

    Matthew 6:25-34 CSB

    The word that the CSB translates in this passage as “worry” is translated in other versions (like the ESV) as “be anxious”. This is not an incorrect translation, as worry and anxiety can be synonymous. However, many people do not understand that, while you can use worry to mean anxiety, and vice versa, use of the term “anxious” or “anxiety” does not necessarily signify worry.

    We all experience worry and fear. If you are a Christian, you also believe that we all sometimes experience sinful worry, where we fail to trust God with ourselves, our lives, or our circumstances.

    I am not saying, however, that all fear is sinful. If you believe that a human being experiencing fear is inherently sinful, you are falling into the ancient heresy of Gnosticism. In brief, Gnosticism denies the goodness of material creation, including the goodness of the human body, believing instead that the spiritual is superior to the physical and that salvation comes through freeing the “self” from the material world. This, of course, is directly contrary to the Christian conception of the world, which is that God created all things and called them good, and in the case of humans, very good. Christians believe that humans are embodied souls that bear the divine image.

    Because God created us as embodied beings, our bodies are integral to our selves. So, for example, if you were attacked by a mountain lion, you would experience fear as a physical response to the danger. In fact, it would be bizarre in this situation for you not to be fearful, because that is how God created you. (There’s a separate discussion to be had about situations causing fear being a result of the fall; I won’t delve into that here, except to note that situations causing fear, and the fear response itself, are two different things.)

    There is a lot more to be said about this, so in my next post, I will continue to explore these ideas and unpack the difference between worry and clinical anxiety.

  • Help Me Understand Your Anxiety Disorder: An Introduction

    I have an anxiety disorder. The official diagnoses are Generalized Anxiety Disorder and Panic Disorder. I am open about the fact that I have an anxiety disorder. If you have talked to me much, especially if we’ve talked about spiritual things, you almost certainly know this already. I make an effort to be open about it, because there tends to be so much secrecy and shame around mental health issues, particularly in the church. I’m not interested in that. I don’t think it’s something to hide, or be ashamed of. And as far as I’m concerned, vulnerability begets vulnerability. So I go first, and I hope that by talking about it, it helps others feel free to talk about their struggles, wounds, and challenges–whether it’s a mental illness, or something else.

    Often, when I explain what it is like to have an anxiety disorder, people respond with something along the lines of: “I had no idea that’s what it was like,” “I never understood what an anxiety disorder was,” or, “No one has ever explained it to me like that before!” These responses aren’t super surprising–we all know that mental health issues are not discussed much, if at all, particularly in the church–but they’re heartbreaking for me nonetheless. Anxiety disorders are not uncommon, and so the fact that the vast majority of people have little to no understanding of them means that most people are routinely interacting with people suffering from these disorders with absolutely no understanding of the suffering being experienced.

    I’ve wanted to write more about this issue for a long time, because I want to help people understand. A few months ago, I had yet another conversation with a friend who asked me to explain what it is like to suffer from an anxiety disorder. How do you know, she asked, when it’s a chemical imbalance, and when it’s simply sinful worry? After we chatted, she was blown away. I mentioned that for a long time, I had been thinking about starting a blog to share some thoughts that have been helpful for me and others about this and other issues.

    “PLEASE DO,” she said. So here I am.

    I’m going to be writing a series of posts talking about what it’s like to live with an anxiety disorder. I plan to discuss terminology, clinical anxiety versus sinful worry, the actual experience of having anxiety and panic disorders, medication, and some thoughts on spiritual practices for those who suffer from anxiety disorders. If you have questions or thoughts about anything that you read or have other topics that you would like to see covered here, please reach out so that I can make these posts as helpful and beneficial as possible!