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Mental health from the trenches

A Presbyterian pastor hosts a remarkable webinar for the Presbytery of San Jose and for the wider church

by Mike Ferguson | Presbyterian News Service

Part of the Rev. Ryan Althaus’ inpatient treatment was of the equine variety. (Photo courtesy of Ryan Althaus)

LOUISVILLE — The Rev. Ryan Althaus, the founder of Sweaty Sheep and the Hunger Advocate for the Presbytery of San Jose, convened a thoughtful and moving webinar over the weekend on mental illness and the church. His first-person story is told with candor and grace in the sidebar below.

“Be graceful!” Althaus urged the 25 or so people listening in during Saturday’s webinar. “We all have unique wisdom.”

Althaus opened by discussing a bit of his own journey, which is more fully described in his article.

“It’s something we hardly ever do, opening up to people who are our best supports,” he said. “Being vulnerable and transparent is what’s gotten me through.”

Healing from a mental illness is a lifelong process “that can be incredibly life-giving,” he said. “I wouldn’t trade the pain. It’s a lot to take, but I’ve grown a lot from it.”

River Krimmer

Althaus introduced River Krimmer, a licensed marriage and family therapist and founder of Living Evolution.

Krimmer called mental health “that connection a person has to the world — how we live, function and show up.”

“We all get a hand dealt to us,” he said. “It is up to us to figure it out. It’s easy to get stuck in patterns and routines that perpetuate suffering.”

Getting support nowadays “is more accepted than it has ever been, and that makes me excited,” Krimmer said.

Most of Krimmer’s work occurs with clients in an outdoor setting — especially since the onset of the pandemic, he said. One example” he often does couples counseling on Northern California beaches.

“I’m grateful Ryan and I were brought together,” he said. “We both believe connection and the lack thereof is one of the greatest deficits in our culture.”

Webinar participants said they were grateful to hear from both Althaus and Krimmer.

“So much of what you had to say resonated with me personally,” said one, a psychologist. She called the conversation “a reminder there is a real benefit to this level of transparency, which connects us to each other.”

“In my heart of hearts,” said the Rev. Erica Rader, Stated Clerk of the Presbytery of San Jose, “I hope we can put together the gifts and resources we have as Presbyterians who seek to bless our communities and be interfaith and ecumenical.” The goal, she said, is to “figure out how to convene places of wholeness and wellness together … We have been praying for this day. My colleague Ryan has been a blessing to me and to all of us.”

“The need out there is enormous,” said another participant, “and the resources are paltry.”

Another, a  pastor who’s been dealing with PTSD for many years, said, “I wanted to get ‘the Reverend’ in front of my name so that people will listen to me when I talk about mental illness.” She called her current congregation “amazing. They know what I have offer,” she said, “and what I need.”

Information on the Presbyterian Church (U.S.A.)’s church-wide mental health network can be found here.

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‘Accepting my brokenness’

 A pastor trained to minister to people in a psychiatric ward is himself ministered to

by the Rev. Ryan Althaus | Special to Presbyterian News Service

SANTA CRUZ, California — I remember the first time I walked through the secured steel doors of an inpatient psychiatric unit. It was 10 years ago. I was dignified, hopeful and even “sane,” according to sociological standards. Thus, with a freshly signed master’s degree on my wall, a soul overflowing with excitement and anticipation, and a paisley tie dangling down from my neck to embellish my shiny new name badge, I dove into a new phase of life. I was a chaplain-in-residence and the poster child of pride and purpose.

Pride is a peculiar animal — and as many of us have come to discover, it can prove to be a slippery slope. A decade later I slipped down that slope and once more through the double doors of an inpatient a psych institute. However, this time I was destitute of the dignity of that first pass. I was demoralized, hopeless and labeled “insane,” according to sociological standards.

My diploma had long since been stored away and now I glanced down at the freshly-signed admittance papers that lie before me on a cold table. A pair of ironically-patterned paisley hospital scrubs dangled over my emaciated body. The excitement and anticipation I’d felt that first visit had fallen to anxiety — and any lingering pride was stripped from me at the door alongside my clothes, phone, computer, and any other belongings that might distract me from accepting my brokenness. The removal of distractions proved to be a profitable yet painful predicament given the proverbial truth that anything short of acceptance is avoidance— and my accepting that it was those decades of avoidance that had brought me back to a psych unit.

Yes, I well remember the first time that I walked through the doors of an impatient psych unit. Now I journal about the experience with a pre-dulled pencil under the watchful eyes of a team of nurses and psychiatrists while trying not to let any falling tears dampen my paper.

“You must be Ryan.” A soft voice stopped me from scribbling.

“I am.” I peered up at the tall figure before me.

“I’m Jeff,” he declared as he sat down beside me. “I was told you wanted to meet with me. I am the chaplain here.”

“Great! Thanks for coming.” I set down my pencil, and with a slight smirk towards the clergyman added, “I must admit, I like your seat better.”

“Oh, um …,” the initial confidence in his voice softened to uncertainty. “Well, you can sit here if your seat is uncomfortable.”

“Ha! No need. Our chairs are both the same.” All the furniture in the unit was sterilized, standardized and connected to the floor to prevent being thrown across the room. “My discomfort doesn’t derive from the literal seats we are sitting on — though I cannot say they are the epitome of comfort, either. It is actually the role of patient that I’m uncomfortable with.” I paused to assess my own situation before concluding: “A couple days ago I was a Presbyterian minister ironically trained as a psych chaplain.”

“Really?” Jeff’s attempt at politeness and political correctness curbed his curiosity and kept him from asking the question we both knew was on the tip of his tongue: “What the heck happened?”

That was a question I’d been asking myself. What the heck had happened?

The simple answer was that I’d lost my why — my sense of self and purpose. We have all been there, but for those preconditioned to mental illness, when our reason to wake dims we lose our ability to reason.

Let me start by stating that I have struggled secretly with mental illnesses throughout my life. Many have — or at least the labels of such. From bipolarity to obsessive compulsive disorder or depression to anxiety, our society loves to label. However, like many, my mental illness — an eating disorder that ate away at my soul — remained hidden behind a charismatic kid with lots of energy and a big smile. A grin is great, but pain can only stay hidden so long. For as the old adage claims, “trauma not transformed is transmitted,” and the inner turmoil and trauma transmitted through my 20-some years battling with an eating disorder finally institutionalized me.

“Mental illness” is a prevalent term in our daily dance through the world of the “well,” but it is also a term packed with preconceptions and prejudices that can easily isolate those self- or socially-labeled “ill.” Preconceptions aside, what I’ve come to find through conversation and personal experience is that mental illness is really just an alternative and stigmatizing means by which society defines personality. It’s a pretty prominent personality trait, given that roughly 1 in 5 adults struggle with mental illness and 1 in 25 people are paralyzed by it.

Given statistics such as these, I have no hesitations nor find any shame in sharing my recent personal experiences. Instead, I am excited for the healing conversation.

My eating disorder first developed around the age of 7 when I found food to be an easy means through which to control the uncontrollable emotions of my father’s diagnosis with terminal colon cancer. I’d exhibited compulsive traits since birth, but it was at this time that I started hoarding tasty cakes and stealing snacks from my big sister, starving myself for long hours before bingeing behind closed doors. Exercising until exhaustion exhausted the inner guilt that defined my life, faith and feelings.

Fast forward through 30 years of manic and depressive cycles — notably with the manically happy, successful and social years speaking louder than the hidden depressive ones — and my dance with the disorder eventually dropped my heart rate below 30 beats per minute, stole 20-some pounds I didn’t have to lose, and landed me in the ICU en route to the psych institute.

I was lucky. Lucky because I made it to the hospital before the most deadly of mental illnesses took another life. But moreover, lucky because the outward implications of my dance with death made my diagnosis undeniable. The earlier alluded “1 in 5” statistic is scary.

Scarier still is knowing that statistic counts only those who admit to their “illness,” and that only about half of that initial 20% of our population actually seeks help.

An eating disorder is unique in the field of mental illness because it is visible. Thus my frail figure was not something that could be easily hidden. Ignored? Indeed; however, that is because we are scared to talk about mental illnesses — not because they don’t exist.

Depression, unlike anorexia, doesn’t have a defining look. Nor does anxiety bear an outward appearance. The voices of schizophrenics go silent to the world around them and the suicidal thoughts of a struggling society can be easily swept away under our superficial smiles.

So when is it time to stop avoiding our illnesses and reach out for help? And to whom or how do we do so?

 As Jonah puts it in Jonah 2:5-7, “The waters closed in over me to take my life; the deep surrounded me; weeds were wrapped about my head at the roots of the mountains. I went down to the land whose bars closed upon me forever; yet you brought up my life from the pit, O Lord my God. When my life was fainting away, I remembered the Lord, and my prayer came to you, into your holy temple.”

 I love the story of Jonah when meditating on mental illness. Not only could most of the ancient prophets be perceived as mentally ill by their respective societies, given the schizophrenic voice of God they claimed to hear or the cycles of anxiety and depression that circled around their call. But their narratives provide excellent expressions of vulnerability and surrender.

Jonah provided the perfect picture of depression as he sat baking in the sun under a tree, claiming, “It would be better for me to die than live (Jonah 4:8)” before presenting the perfect portrayal of denial by “fleeing the voice of the Lord” en route to getting swallowed by a whale.

What I love most about the story of Jonah is that it provides proof that God will keep encouraging us to seek healing despite how hard seeking help can be. What Jonah and all of us most struggle with is finding the humility needed to seek help.

C.S. Lewis’s reflection that “humility is not thinking less of yourself, but thinking of yourself less” is helpful when speaking of a condition that can make any individual incredibly self-focused and overly introspective. Thus the first step to healing is to step out of our mind and humbly open ourselves to the world. Healing requires acceptance, acceptance requires humility, humility requires surrender, and surrender — and only surrender — leads to transformation. Also keep in mind that “trauma not transformed will always be transmitted.”

 I’ve never understood what humility and surrender truly meant until giving myself away to an inpatient hospitalization program. Despite the daily deluge of tears, I’ve never been so grateful for any experience. For two weeks I could not choose when or what I ate, when I woke or went to bed, or even when I was allowed to stand or sit. It was only by surrendering all these decisions and perceived physical freedoms that my mind became free to fly and with the worries and what ifs of the world aside, I was able to surrender my spirit to something greater: healing. And in that I had to honestly answer Christ’s questioning: “Do you want to be made well?” (John 5)

What is well? One of the reasons we do not seek help is because we don’t understand healing of the mind in the same way we do the body. Instead, society looks at mental illness as a lifelong internal leprosy. However, like any physical illness, healing is more than possible.

Unfortunately, healing from an illness of the mind and soul is not as easily defined as is an antibiotic or surgery and often proves to be a lifelong process.

But it’s a lifelong process that can be incredibly life-giving given the self-awareness and appreciation of someone who has recovered from a mental illness in addition to their enhanced ability to heal and empathize with others is significantly enhanced. That much said, you can only help others if you first help yourself —and helping others in the long term is the best way to help oneself.

I tried hard to deny that I needed inpatient treatment in the months leading up to finally raising the white flag of surrender. But when one of the individuals from the recovery home I serve died by overdose, it made me realize that my disorder had stolen my ability to be present with and be a healer for others. The anxiety and introspective nature of a mental illness can steal one from being present with the people in their lives. My reaction to the loss of one of our residents was to run. Literally, running to the trails — alone — to address my personal emotions by defaulting to my exercise addiction as the 13 remaining residents of my program sat in need of support.

It was while running through the redwoods that I realized that I had allowed my eating disorder and the anxiety associated with it to steal me from the role of healer and it was then that I realized I needed healing and in the weeks to come I would further realize that surrendering to treatment was not a sign of weakness, but the strongest thing that I could do. It was also then that I had to ask myself what healing meant.

I remember praying that night while wandering the woods: “God, grant me peace.” Peace to make it through the next days. I pleaded, then paused, knowing that I would never be strong enough to surrender my will to God’s. That is the problem with mental illness. During times of adversity one is too lost to logically seek support, but during times of “sanity” life seems manageable enough to put off seeking treatment. So I continued to pray. “Grant me peace, and then break me!”

Indeed that evening I found peace, but several days later, when the doors to inpatient treatment opened, I broke. I wept a lot throughout the weeks of forced meals from within the confines of the eating disorder unit, but as the tears started to dry and I started to open my heart and eyes to the other residents and staff, I dove into a deep inner dialogue about what recovery was and what it meant to be “well.”

“Do you want to be made well?” Jesus questions a leper. That verse never meant much until I started to seek out what “wellness” was. In Greek the word “well” is associated with wholeness. Do you want to be whole? And in my mind that means holistically whole — mind, body and spirit. Moreover, in understanding mental illness as that afore-alluded personality trait, wellness or wholeness means being wholly who we are.

So another question I’d heard in the past came to the forefront. “Who was I before the world told me who to be?” Who was I before my eating disorder stripped my spirit, and who did I want to be upon reclaiming it? That is a question that we must all ask ourselves as we recover from any ailment — inner or external, addiction, insanity or illness. Who are we called to be? Furthermore, how do we become that person?

Recovery is different for us all, but one common thread sews our souls together. Recovery does not happen in isolation. Thus we are each called to put aside the pride that imprisons us. For me that meant enlisting those whom I normally strive to serve as my supports, the same people that I worked so hard to keep my disorder secret from.

Coming out of inpatient care I reached out to my congregation and the recovery residents I served. I scheduled lunch dates knowing that I needed the support and empowerment of others to make it through midday meals. In doing so I found that I empowered each by enlisting their help! I was helping each individual whom I’d asked for help further find their own purpose, because at the end of the day that’s what we all seek — purpose. To know that we are here for a reason given the essential purpose of life is quite simply to find purpose in life. It is then, when we reveal our purpose, that the healing — self, social, spiritual and physical — starts.

Something else happened when I opened up to others: I started to laugh again. It was during those early lunch dates as I told stories about how I broke into tears in the hospital over a sugar cookie and cup of sorbet that I was able to smile at the situation — and it is when we start to smile and giggle about the goofiness and “insanity” of our idiosyncrasies that we can stop taking ourselves quite so seriously. It is in community that we are able to come together through the unifying gifts of laughter, our imperfections, and the awareness that “life is far too important to be taken seriously.”

Mental illness is indeed a serious thing, but the seriousness of the stigma surrounding it is something our society must overcome if we ever want to be made well.


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