Mental Disorders & Our Ministries

1. Mental Disorders & Our Ministries The Reverend Dr. Kelly Murphy Mason, Psy.D., M.Div., M.S., LCSW-QCSW: Clinical Pastoral Psychotherapist in Private Practice in NYC; Community Minister in Metropolitan New York

2. Simple Formulas for Complex Phenomena Stressors/ = Psychological Supports Distress Psychological Distress + X = Mental Disorder (Clinical condition-Psychopathology)

3. Multidimensional Disorder • Psychospiritual* • Sociocultural • Biophysical • Cognitive/Behavioral

4. Assessment vs. Diagnosis • Assessment accounts for multiple factors and is therefore “multiaxial” • Diagnosis is a medical term • Diagnosis is both organized & coded in the DSM, published by APA • Psychiatrists provide medical management for mental disorders, using prescription psychotropics in their pharmacotherapy

5. Categories of Disorders • Developmental Disorders • Dementia • Substance Abuse/ Dependence • Schizophrenia & Psychotic Disorders, inc. Paranoia • Dissociative Disorders • Somataform Disorders • Eating Disorders • Sleep Disorders • Sexual/ Gender Identity Disorders • Personality Disorders • Factitious Disorder • Impulse Control Disorders • Adjustment Disorders • Anxiety Disorders • Mood Disorders

6. Commonly Occurring Disorders • Anxiety Disorders include: Panic; Phobia, including Social; OCD; PTSD; and Generalized Anxiety Disorder • Mood Disorders include: Dysthymia, Major Depressive Disorder, Single Episode or Recurrent; Bipolar Disorder; Mood Disorder due to…

7. Depressive Disorders, a.k.a. “The Common Cold” • Some disorders are self-limiting • Episodic depression tends to worsen • Self-esteem is often damaged • Social isolation becomes problematic • Neurovegetative symptoms are real • Depression can be “masked”, esp. in males, who are at higher risk for suicide • Mania and psychosis sometimes figure in the disorder

8. “Comorbidity”, or: The Double Whammies • Depression & Anxiety-Spectrum Disorders frequently are comorbid, sometimes difficult to distinguish • Depression can be secondary to a general medical condition • Substance-induced mood disorders require dual diagnosis and specialized treatment

9. Substance-Related Disorders • Alcohol Use • Amphetamine Use • Cocaine Use • Hallucinogen Use • Opioid Use • Inhalant Use • Cannabis Use • Sedative/Anxiolytic Use – the “iatrogenic effect” • Polysubstance Dependence • Substance Intoxication • Substance Withdrawal

10. Common Psychotropics • Antidepressant SSRIs: Prozac, Zoloft, Lexapro, etc. • Atypicals: Wellburtin & Effexor • Anxiolytics, inc. benzodiazapenes: Xanax, Ativan • Mood stablizers, eg. Lithium • Antipsychotics: Abilify, Zyprexa • Psychostimulants: Ritalin, Adderall • Sleep aids: Remeron

11. Levels of Functioning • People often attempt to self-medicate with substances or self-soothe through the so-called “soft addictions” as a coping strategy • Some people may be higher functioning, others lower functioning • Some internalize, others externalize • Some people are in an acute phase, others in the management stage • Many mental disorders go undiagnosed

12. The Stressors: Psychosocial & Environmental Problems • Problems with primary support group, i.e., the family or marriage • Problems in the social environment • Educational/Occupational problems • Housing problems • Economic problems • Problems with health care

13. Spiraling Up or Down: Positive & Negative Feedback Loops • People may need to strengthen their relational skills and coping strategies, as well as adjust their mental schema • Good “hygiene” includes self-care honoring the mind-body-soul connection

14. Caring Congregations • Strong spiritual community & solid pastoral care can provide protective benefits • Preventative mental health care is optimal • People feel dignified by a holistic approach to themselves & their situations • A healthy congregation can be a therapeutic milieu

15. Supporting Congregantswith Mental Disorders • Preach compassion • The faith community can work as a collective to both destigmatize and normalize mental disorders • Psychoeducation can be a very important part of church programming & congregant learning • Social justice groups can advocate for mental health parity • Peer support and group work fill significant needs, especially if they are offered in a safe environment

16. Areas of Pastoral Attention & Psychological Concern • Relational problems • Possible abuse, history of abuse • Spiritual or religious problems • Bereavement or complicated grief • Acculturation • Phase of life problem

17. Holistic Care • Interpersonal supports need to be enlisted • Psychotherapy is quite effective, both short- or long-term, and in combination with pharmacotherapy • Education and empowerment are linked in such treatments as bibliotherapy • Mental disorders tend to leave marks that last for a time…

18. Notes for Religious Professionals • Tend to your own mental health! Take good care of yourself… • Acquaint yourself with the spectrum of mental disorders • Know and respect your limits

19. Limits of Congregational Care • Ministers and religious educators are not generally qualified as providers of mental health care and so must have an understanding of when professional mental health care is needed • Ideally, some sort of referral network is established before it is needed in a time of crisis • Certain conditions are chronic and not necessarily ever “cured”

20. Managing Personality Disorders • Obsessive-Compulsive Personalities • Histrionic Personalities • Paranoid Personalities • Schizotypal Personalities • Dependent Personalities • Borderline Personalities • Avoidant Personalities • Narcissistic Personalities

21. Warning Signals to Heed • Grossly disorganized behavior • Delusions or hallucinations • Indications of decompensation • Suicidal statements, threats, or gestures • Menacing actions • Serious expressions of concern

22. Responding Without Pathologizing • Remember that mental disorders tend to have involved etiologies • Those struggling with mental disorders are much more than a coded diagnosis and may retain their signature strengths • Treatment outcomes for mental disorders continue to steadily improve, even in cases of recurrence • Eliminate us-and-them thinking, since lifetime prevalence is high

23. Resources Available • The Caring Congregations Program • Online sources such as www.mentalhealth.com • Advocacy groups such as NAMI • Public organizations such as NIMH • Phone services like 1-800-LIFENET • Local counseling centers and hospitals

24. Questions and Answers Q: ? A: “It depends…”