Physician Assisted PTSD – When Bad Medicine is Disguised in a Mental Health Diagnosis

Rebecca Frech wrote last year about her doctor-induced case of PTSD:

And in that moment, I can tell by her face that no one has updated the chart. It still says Conversion on the line for diagnosis. Nobody has put in the test results and new diagnosis from last October. I can see it as plainly as I can see that her eyes are brown. We’re still suspect, and this still isn’t over.

This week she updated with the news of the definitive diagnosis for the medical reasons behind her daughter’s paralysis.  It would be easy to think that Ella Frech’s case is an anomaly.  We might think that it’s unusual for a serious medical condition to be dismissed as a pscyhological disorder.

It isn’t.  It is woefully common, and there’s a reason for it.

The Diagnosis that Doesn’t Discriminate

It isn’t only Acute Motor Axonal Neuropathy that gets the nutcase treatment.

Stephen Gaudet writes here about being accused of faking his severe asthma:

Feeling proud about what I had accomplished through daily exercise, I shared my marathon story with one of the intern doctors who was assigned to me. Rather than congratulating me, he basically accused me of faking my asthma. His words were ” There’s no way you could’ve walked a marathon if you have severe asthma.” I found out later that in my chart he actually wrote, “patient presents with factitious asthma, claims he walked a marathon“. That probably explains why some of the nurses were treating me so strange during the hospitalization. A rumor had spread that my asthma was very mild and probably psychosomatic in nature. I remember some of the medical staff trying to convince me that my breathing difficulties were all in my head and that I had some kind of generalized anxiety disorder. Are you freaking kidding me! And even scarier, this happened at a well respected teaching hospital.

That incident caused me a lot of grief and took over 3 years with lots of letter writing by my pulmonologists to have that false information removed from my medical record. The reality is that these are the kinds of screwy preconceived generalizations that people have about the way sick people should look and behave. And if I want to be completely honest here, there have been times when I’ve guilty of the same.

For background: Gaudet is a respiratory therapist who is treated by one of the top pulmonologists in the nation.

Here’s Dr. Michelle Roger, a neuropsychologist, writing about the mental health misdiagnoses of patients with dysautonomia:

Just about every Dysautonomia patient with whom I’ve spoken over the last few years has, at one time or another, been told that the symptoms they were experiencing were all in their head. Diagnoses such as Anxiety disorders, Depression, Conversion or Somatoform disorders, and even Bipolar disorder are haphazardly applied to patients when no clear aetiology can be discovered to explain their symptoms. Normal reactions to abnormal situations, and purely medical/physiological symptoms are over-pathologised or misdiagnosed with alarming regularity, and to the detriment of the patient.

When unfounded these diagnoses leave a mark on the patient, a wound which if left untended will follow and influence all future relationships with the medical professionals. It also leaves a glaring mark on medical records that will be incorporated into future investigations and the overall diagnostic process. Even when unsubstantiated or proven to be untrue following psychological assessment, it can prove extremely difficult to remove such diagnoses from a patient’s medical file.

Here’s a summary of Dr. Alex Flore’s presentation on the problem of mitochondrial disease being misdiagnosed as Munchausen syndrome by proxy:

It is possible that what may be interpreted as “red flags” of Munchausen’s may alternatively  be attributed to the demands and anxiety related to care of a very sick child.  For example, anxious parents may not give a good history, or may “doctor shop” because they are unsatisfied and may be unhappy with the care their child is getting, especially when they feel that no one can actually diagnose, treat or understand the problem.  Certain conditions, especially mitochondrial disease, will present with intermittent symptoms, and it will take a skilled and patient clinician to arrive at the right diagnosis – one that is an illness not Munchausen’s by proxy.

Psychologists have described that the population of patients and parents of children with Mitochondrial Disease are much more vulnerable to a false Munchausen’s by proxy accusation simply due to the nature of the disease.  In fact, a hallmark characteristic of mitochondrial disease is the presentation of several unrelated symptoms that together, “don’t make sense”.  Clinicians who feel that a parent is intentionally making symptoms appear, is behaving to insure that the illness continues, and consults multiple physicians may suspect Munchausen’s – but should still “trust, then verify.” In other words, believe the parents, run appropriate diagnostic tests, seek the input of every part of the child’s team, and take very seriously the responsibility to the child to act as an advocate and do no harm.

Non-psychiatric misdiagnoses happen, too, of course.  It is frustrating when a physician (or team of physcians) flubs a diagnosis through honest error — we humans aren’t ominiscient, so it’s bound to happen.  It’s galling when the misdiagnosis involves dismissing serious serious symptoms as some much more benign illness that doesn’t fit with the case history.  But pushing off a poorly-substantiated mental health label on a patient with an atypical presentation is both physically and emotionally harmful to the patient.

Unfortunately, this dangerous habit is actually enshrined in medical practice.

I Guess You’re Just Nuts, Then?

Many misdiagnoses are just idiocy.  Some popular lazy-diagnoses include fibromyalgia, depression, and anxiety disorders.  All of these disorders have specific criteria you can use to evaluate yourself (or your patient) and see if they apply.  It’s almost helpful when a physician throws out with confidence, “I think it’s probably just ________” and inserts some illness utterly outside his or her specialty, and which a quick Google search would immediately rule out. Then you know you have a stupid doctor, done.  It’s wearying, and can put you off the medical profession for a while, but it’s possible to come to a definitive conclusion one way or another.

There’s at least one mental health diagnosis, however, that can’t be ruled out by logic and good medicine.

Conversion Disorder, which is what Ella Frech was persistently misdiagnosed with (despite presenting with symptoms of a known side effect of one of the medications she was taking), is where modern medical practice bares its hubris.

Here’s the Mayo Clinic describing how Conversion Disorder is diagnosed:

There are no standard tests to check for conversion disorder. The tests will depend on what kind of signs and symptoms you have — the main purpose is to rule out any medical or neurological disease.

In other words, and you can read the whole page and see for yourself, if you’re definitely sick but no one can figure out why, then conversion disorder.

That’s it.

Dr. Allen Frances writes at Psychology Today about the failed effort to get the DSM to attempt even a modest stab at valid diagnostic criteria above and beyond heck if we know:

Many of you would argue that I didn’t go nearly far enough- that there should be no ‘Somatic Symptom Disorder’ at all in DSM 5 because there is no substantial body of evidence to support either its reliability or its validity.

. . . I am sympathetic to this view, but realized that it would have no traction with the work group and chose instead to lobby for what seemed to be clearly essential and relatively easy changes that would solve most, if not all, of the problem.

. . . My letter cautioned DSM 5 that it was invading dangerous territory. Here was my warning to the DSM 5 work group:

• ‘Clearly you have paid close attention only to the need to reduce false negatives, but have not protected sufficiently against the serious problem of creating false positives. You are not alone in this blind spot—in my experience, inattention to false positive risk is an endemic problem for all experts in any field. But your prior oversight needs urgent correction before you go to press with a criteria set that is so unbalanced that it will cause grave harms.’

• ‘When psychiatric problems are misdiagnosed in the medically ill, the patients are stigmatized as ‘crocks’ and the possible underlying medical causes of their problems are much more likely to be missed.’

• ‘Continuing with your current loose wording will be bad for the patients who are mislabeled and will also be extremely harmful to DSM 5, to APA, and to your own professional reputations.’

I also raised the point that this could lead to a boycott of DSM 5. Pretty strong stuff, I thought. But totally ineffective.

Somatic Symptom Disorder (which is the umbrella term in the current terminology under which Conversion Disorder falls) is thus a particularly hazardous diagnosis because it has no symptoms of its own.

It is literally a disorder whose defining symptom is, “We the physicians don’t know what you have.  Therefore, it must be psychological.”  This is an awkward assertion for a profession that has evolved more in the past century than any other field of human endeavor.  The developments in medical research just in the past twenty years are astonishing and marvelous.  My children’s high school biology textbooks are utterly different than mine, because the depth and scope of our knowledge about human cells and the chemistry of the human body is orders of magnitude past what we knew a generation ago.

It seems, therefore, ludicrous that any sane person could hold that our knowledge of medicine is now perfectly complete.  But this is the implicit assertion of somatic symptom disorders.

***

I sometimes joke that idiopathic means that you and your doctor both agree the other person is an idiot.  But really it just means we don’t know.  That happens.  Humans aren’t all-knowing.   What is the sane response to ignorance?  It isn’t to fabricate some fanciful explanation to cover over your lapse.  The sane response is to humbly admit, “I’m sorry I don’t know.”  And, where the stakes are high, the sane person adds, “And we should keep investigating until we get a solid answer.”

File:Cartoon; the nervous system. Wellcome L0004861.jpg

Illustration contains a bit of humor in the fine print, [CC BY 4.0], via Wikimedia Commons.

Animal-Human Embryo Ethics Simplified

A hot newish thing in scientific research is combining human and animal genetic material in order to do something-or-another.  Here’s a quick rundown of the moral issues involved, including “What if there were Cat-People?”

Principle #1: If it directly kills an innocent person, don’t do it.  Some of the procedures under scrutiny involve removing genetic material from human embryos (for whatever purpose, noble or otherwise), and thus killing the embryo in the process.  A human embryo is a human being.  A very tiny, very young, very immature human being, but a distinct human person all the same.  Just because your friends can’t drive or hold down steady jobs doesn’t mean they’re disposable.

Don’t kill the innocent humans.  That’s a hard-and-fast rule.  Therefore, any procedure that requires the direct killing of any innocent person is a no-go. Always and everywhere.

Principle #2: Human beings have eternal souls. Now let us imagine you acquired your human genetic material through some moral means.  A question that then arises is: Does our use of that human body-part cause a new human being to enter into existence?

We have situations in which no such thing happens.  You can donate your kidney and liver and heart and all kinds of stuff to some other person, and the recipient remains one person, the same person as before, and you remain the other. (You might be dead, but you’re still you.)  No new human is created via organ donation.  We can conceive of situations in which the use of human genetic material works in a similar way — the donated body part does what it does, but it doesn’t cause a new human person to come into existence.   In such a case, as long as other criteria for moral action are met, there’s not a problem.

We have, likewise, situations in which the pro-creation of a new human person does or could happen.  It is not necessary for us to analyze the state of science at this very moment.  All we need to know is that if a new human being is made via cloning, genetic donation, or what have you, we’ve violated a moral law.  It is immoral to procreate outside the bonds of marriage.  But, like all the other immoral ways people procreate, we also know that every human person is endowed with inherent dignity that comes from being an eternal soul created in the image and likeness of God — regardless of the circumstances of conception.

Therefore, though it is patently wrong to create new humans via cloning, IVF, rape, adultery, and whatever else science might devise other than the marital act, the new humans so-created still must be treated with all the same rights and privileges the rest of humanity is owed.

Principle #3: When in doubt, err on the side of protecting the sanctity of human life.  People are stupid, though, and sometimes evil. We can envision, therefore, some dreadful situation in which scientists create part-animal-part-human hybrids.  Is this new creature a human being?

Well, that would be hard to know, wouldn’t it?

We could be quite certain that if, say, you donated a human lung to a pig, the pig is still a pig.  We know that because that’s how it works when you donate a human lung to a human.  The recipient remains what and who the recipient always was.  There are moral problems with donating human tissue to animals, for example: Why was a perfectly good human lung wasted on a pig?  Those issues must be dealt with, but they are different from the question of whether the pig just became a human person. The pig is still a pig.  Not one you want to barbecue, though.  Ick.

In contrast, let’s say we created an embryo in-vitro (don’t do that, it’s wrong), but rather than using 100% human genetic material, we used some portion of non-human tissue as well.  The resulting being might be obviously “human” or might not be.  But here’s the rub: You could not count on appearances alone to know whether you had a human person.  Does it look mostly like a human, but really it’s a dog-soul animating a modified dog-body, more like the animal recipient of human organs?  Or, in contrast, does it look mostly like a dog, and lack many of the characteristics we take for granted as being “human” but in fact it’s a human soul animating a damaged human body?

It is quite probable that we might find ourselves in the situation of having to say: Who knows?

And in that situation, the moral response is to assume it’s a human person until proven otherwise.

Conclusion: Baptize the Cat People.

Should you create human-animal hybrid creatures? No!  You shouldn’t be procreating humans in the laboratory at all, unless it’s you and your spouse up late going at it the old fashioned way.  But in the event that hybrid-creatures are produced, we would be obliged to treat them as if they were human, no matter how miserably inconvenient that turned out to be.

 

Related: 

File:The ball of yarn; (1854) (14804043403).jpg

Artwork: The Ball of Yarn (1854) by Internet Archive Book Images [No restrictions], via Wikimedia Commons

Best Practices: Getting Parents Involved in Kids’ Religious Formation

Last week was our parish’s first week of religious ed, and my 7th grade daughter came home with an example of ordinary catechists in a traditional classroom program doing a great job at supporting parental involvement in their children’s faith.

There were three parts of the memo-from-the-teachers that made me swoon with gratitude.

1. Invitations (lots of them) for parents to come join the class anytime.  

I’ve known our DRE for many years and she’s always had a very warm and open attitude towards parents’ involvement in their children’s formation.  But to have the teachers repeatedly invite parents to come sit in class any time at all communicated an important message: They want us!  They’re happy to have us.  They’re happy for us to see what the kids are learning and take an active part in weekly faith formation.

Inviting parents to class does change the dynamic.  It takes confidence and good teaching skills to be comfortable working with an audience.  (And the reality is that watching people teach religious ed isn’t always the most exciting way to spend an hour.  It can be, but sometimes you’re maxed out on sacrament charts and so forth.)  But I love that my daughter’s teachers want me to know I’m not getting in the way.  Me showing up and being involved is a good thing, not a hindrance.

That’s a rightly ordered relationship (even if I never take them up on the invitation), and I think their understanding of that relationship is why they did such a stellar job on the other two very simple helps they added to the class.

 

2. Weekly bring-back-to-class assignment: Noticing God’s action in our lives.

I’m sure the day is coming when we all bring in mini-tubes of toothpaste for the homeless, or spare change for missions, or whatever other project it is the kids are undertaking this year.  Corporal works of mercy are good.  But those works have to spring from a lived relationship with God, or the Catholic faith becomes just another option for Ways to Be Kind to People.

So every week, the teachers are asking the kids to report back one instance when they became aware of the presence of God in their lives — whether in prayer, in the created world, in the action of others, whatever it be.

Does this sound too Spirituality Lite?  Let me offer firm correction:  This is an age-appropriate way for kids to start crossing the bridge from an inherited faith to personal ownership of their faith.  It is an age-appropriate way for the kids to become comfortable with talking about their relationship with God.  It is an essential exercise, because awareness of God’s action in our lives is the foundation of the spiritual life.

Not Lite at all — it’s rock solid stone.  The beautiful twist on this assignment is that by getting the parents involved, my daughter’s teachers are handing us, like a weekly subscription to the spiritual goldmine, an easy way for we parents to get comfortable with talking about discipleship with our kids.  If you actually take the teachers up on this opportunity for the next twenty weeks, they’ll have helped you the parent build a habit of discussing the faith in a profound, personal, and non-adversarial way with your teenager.

This is the catechetical mission lived large: Genuinely assisting parents in their role as the primary teachers of the faith.

3. Weekly do-at-home assignment: A question for parents.  

But that’s not all!  Our catechists are taking it one deeper by sending home a second discussion question as well, which will change every week.  Week One’s question was about promises: What promise have you made recently, and what was the outcome? What was something someone promised to you, and what was the outcome?

I liked this question a ton because it fits totally with the topics that came up in class (vocations and sacraments), it fits with questions about the moral life, and it’s not a “religious” topic even though it’s a religious topic.  It’s not a question that has a “right answer” for the kid to parrot back.  It’s a question, though, that hits a big tender spot in the faith.  If you habitually break promises, or the people who are forming your faith (Mom and Dad) are flagrant promise-breakers, you’ve got a cracked foundation you’re building on.  There’s repair work to be done.  Healing work.

In contrast, if the question reveals you’ve got a solid foundation, then look what’s coming: We need to keep that relationship of trust strong through the next five or ten years.  Further, for you my child who’s preparing for confirmation in the next few years? We need to think about what it is your baptismal promises mean, and what they entail.

That’s a lot impact for a discussion that took about five minutes in the car when I happened to get a snatch of time alone with my daughter for uninterrupted conversation.  Twenty of those through the course of the year?  The possibilities are breathtaking.

Inviting the Parents to be the Parents

The beauty of these assignments is that they help us parents do the part of the job that only we can do.  Catechists can review facts and fill in gaps in the kids’ knowledge, but discipleship is parent-work.  (We were also gently encouraged to get our kids to Mass regularly — another job that only a parent can do.)

I was very impressed by our first week because I felt like my daughter’s catechists understand what’s important and how this all works. When I went by the classroom, they were visibly happy to meet me and get to know me.

As far as I know, my daughter’s teachers are just a couple of ordinary catechists — goodhearted people who love God and love the kids and want to give it their best, but just normal people.  And that to me is a very hopeful thing: Normal people are out there doing smart, simple, easy things to help me raise my child in the faith.

File:Cobh St. Colman's Cathedral South Aisle Window 4 Detail Raising of the Son of the Widow of Nain 2015 08 27.jpg

Photo by Andreas F. Borchert [CC BY-SA 3.0 de, CC BY-SA 4.0-3.0-2.5-2.0-1.0 or GFDL], via Wikimedia Commons

Inside My Apologetics 101 – Faith, Evidence, and Objective vs. Subjective Truth

Today I was subbing for my daughter’s apologetics class, and thought I’d share the letter I sent home to parents, since it covers topics that come up online a bunch.  You blog readers don’t get to see the whiteboard photo referenced below because it has students’ names on it from a chart we made at the top of the hour, and I’m not smart enough to figure out how to blur them out of the image.  For your viewing pleasure, I’ve posted completely different photos at the bottom.  Close your eyes and imagine a whiteboard of illegible black scrawl instead, and you’ll know everything you need to know.

Dear Parents,

Attached is the photo of the whiteboard from apologetics at the end of class. Parents, the kids were starting to get the general concepts we went over, but were still having a hard time articulating the key ideas and applying them. It might be helpful for you to have them go through the picture with you and tell you, as best they can, what it is everything refers to. For your convenience I’ve written all the text in slightly illegible lettering so that students have to rely on their memory to fill in the indecipherable bits — you’re welcome.

None of this is in the book, since I was subbing for our regular teacher (Mrs. K) and just working off notes from a different apologetics class I taught a few years ago. But it’s all important stuff and well worth mastering if you enjoy life as a sane person.

Key ideas to draw out of your child:

1) Objective vs. Subjective truth. In apologetics, we need to be able to listen and identify when the person we’re talking with doesn’t understand the difference between unchangeable truths and those facts that are genuinely a matter of opinion, experience, etc. We need to be able to *explain* the difference between subjective and objective facts to friends who don’t realize there is a difference, or don’t realize when they are treating an objective matter as a subjective one. We need to know whether a given statement is a matter of subjective opinion or objective truth.

2) Types of evidence. There are different types of evidence for different types of things. Scientific laws, or laws of nature, are discovered and proven using the assorted tools of science to verify repeatable tests and observations. The facts about historic events and persons are established using the types of evidence that apply to persons and facts. You can’t, for example, do a series of scientific tests to know that Christopher Columbus existed — but you can collect historical evidence for that fact. We need to be able to know, therefore, what *kind* of evidence is suited to proving which kinds of facts. Because God is a Person, and because God acts in history, the types of evidence we are looking for are the sorts of evidence we use for determining historical events and the existence of persons.

In apologetics we need to be able to identify when someone we are listening to has the notion that God is a force of nature that should be subject to scientific evidence, and clarify and explain that God is a person and therefore a different type of evidence is valid. We want to be able to walk our friend through the rational, evidence-based types of proof that one would use in determining whether or not a person exists or an event took place. A useful tool is to walk the person through the types of evidence for or against their own existence.

Not on the board, but an important idea which we discussed in class: Faith is the action of taking the evidence we’ve gathered and using it to come to a conclusion. I can gather all kinds of evidence about the existence of gravity or the existence of Christopher Columbus, but ultimately if I believe in either of those, it is an act of faith. My faith isn’t separate from and certainly not opposing evidence and reason; rather it is the follow-on to gathering evidence and using my reason. Think of it as the third step: Evidence + Reason (logic) + Faith = Belief.

I might be a person who comes to faith easily, requiring very little evidence and logical analysis before I take the leap of faith. For example: I believe in asteroids even though I’ve never had any personal experience with one, and know almost nothing about them. I have an even stronger faith in the existence and power of tornadoes, which I’ve also never seen, because I’ve got even more evidence and experience and knowledge about them — even though all my knowledge is second- or third- hand. Ultimately, though, if I wanted to disbelieve in their existence, I could. Faith is the leap I make to assert that I do in fact believe in these things.

I might, in contrast, be a very skeptical person. Imagine if I decided I would only accept a belief in tornadoes after extensive study and firsthand experience. All the same, even if I were very skeptical, if I’m a rational person there will be some level of evidence that is eventually sufficient to allow me to make the leap of faith and affirm that yes, tornadoes do exist. I can be very skeptical — that is, be a person who requires large amounts of evidence and long periods of logical analysis (reasoning) prior to coming to faith, but still make a decision to affirm or deny a fact. Faith is the act of affirming or denying facts.

[I didn’t use tornadoes or asteroids as examples in class, so that’s new fodder for you in chatting with your child.]

We acknowledged as well, in class, that there are people who simply refuse to accept any level evidence. In class we imagined someone who might, for example, dismiss my (Mrs. Fitz’s) existence, even if they met me in person, on account of how perhaps it was a hallucination, or an actor was paid to pretend to be me, or some other thing. Likewise you could imagine someone explaining away the existence of tornadoes by offering some alternate theory of why they thought they saw a dark whirlwind and heard loud noise right before their possessions were blown away. In apologetics it’s important that we distinguish between someone who is simply looking for more evidence to work through rationally prior to coming to a conclusion, versus those who would never be satisfied with any level of evidence, because they have made a decision in advance about the truth of this or that assertion.

(We didn’t practice this, but a good method for finding out where someone stands on this is just to ask them. Listening is the #1 skill in apologetics.)

Finally, a point that came up in class a couple times is that in apologetics we must be very precise. Please assure your students that in class it’s good to be brave in discussing ideas even if you aren’t sure of the right terms or facts; we will simply pause and clarify definitions as necessary. We learned the word omniscient, and affirmed that none of us humans are omniscient, so it’s okay if you have to acknowledge you don’t know something, and it’s okay if your friends help you clear up any misunderstandings you have.

Have a great weekend!

Jen.

File:Líneas de Nazca, Nazca, Perú, 2015-07-29, DD 46.JPG
 Eerily apropos photo by: Diego Delso [CC BY-SA 4.0], via Wikimedia Commons

And here’s a tornado, because: I’m a believer.  No tornado-deniers at my house.
File:F5 tornado Elie Manitoba 2007.jpg

Photo by: Justin1569 at English Wikipedia [GFDL, CC-BY-SA-3.0 or CC BY-SA 2.5-2.0-1.0], via Wikimedia Commons

Parish Communal Life – When Dysfunctional is Normal

So here’s a weird story that was a wake-up call for me:

I was getting the high school kids signed up for youth group, and one of the forms was a bit of information from the parents — contact info, are you available to chaperone, does your kid have dangerous food allergies, etc.  Necessary stuff.  Now right after the parent email and phone number lines was:

Preferred method(s) of contact: ____________________________________

Because I am a bad person, I answered the question honestly.

Preferred method of contact: In person.

Now allow me to say right now that I don’t actually expect our youth ministers to personally hunt down me and every other parent of a student in the program just to let us each know that they need someone to bring plastic cups this week, thanks.  I do live a little bit in this century.  (And I solemnly promise to clarify that on the form before I turn it in tonight.)

But this lapse of mine got me thinking.  Why was my writing that answer such a radically crazy,  even potentially offensive or alarming thing to do?

Let’s review the facts:

  • The youth ministers and our family attend the same parish.  We’re part of the same Christian community.  (We even show up at the same Mass most Sundays — which defies the odds, but we’re lucky that way.)
  • The youth ministers are taking on the task of mentoring our children through their final years of Catholic youth.  Next stop is full-fledged adulthood.
  • These are the years when kids make tremendous decisions about their vocations, their relationships, and even whether they’ll continue practicing the faith.
  • For the next few years, it’s quite likely that after my husband and myself, the kids’ youth ministers will be the other set of practicing Catholics with whom my children have the most frequent and most significant contact on a regular basis.

This is a big deal.

What youth ministers do — their role in the work of the Church — is huge.

But our concept of communal life in the Church has become so watered down that I feel brazen for even suggesting that such significant persons in our children’s lives should speak to my husband and me in-the-flesh as an ordinary, habitual mode of communication.

***

We’re used to this.  In my years as a catechist in a traditional religious ed program, I typically met my students’ parents one- to -three years after the school year ended.  (Format: I’d run into the kid at a parish event and ask, “So are these your parents?” and that’s how we’d finally meet.)

Once I had the chilling-but-fortunate experience of being in the room while a parent explained to the DRE about a problem in my religious ed class the previous year.  [Sadly: A problem I could have fixed if I’d known about it, but it was the sort of thing you can only know if the parent or student tells you.]  The reason the mother felt so comfortable laying out her problem right there in front of me is that she had no idea I had been her child’s teacher.

Not knowing people is the norm in parish life.

***

This is wrong.

There are many causes of this problem and only one complicated, difficult solution:  We Catholics need to spend more time living with each other.

That’s all I know for now.  If our youth ministers hadn’t posed that foolish question, I probably wouldn’t have even thought about it, I’m so used to living with this problem, and so used to treating it like normal life.  But at least now I’m more deeply informed of what’s not happening, and can start looking for ways to change my tiny part in all this.

File:Bosque de Piedra, provincia de Varna, Bulgaria, 2016-05-27, DD 73.jpg

Photo: Diego Delso [CC BY-SA 4.0], via Wikimedia Commons

Update on the Radio Silence

Short version, since last I wrote:

  • The kids started school! 3/4’s are being farmed out to TOTAL STRANGERS, and 1/4 is home with me, thriving in the silence that comes from emptying the house each day.  So I was offline for a bit, focusing on the transition and all that.
  • Then 1/4 of the children came down with the wicked nasty evil virus you don’t want.  Thank goodness it was the homeschooled child, I think I would have cried if I had to pull a kid out of school for a week with an uncontrollable fever during the child’s first week of school ever ever ever.  Instead: Documentaries were watched.
  • Then 1/2 of the parents caught it (me).  Not as badly, actually!  More tropical depression than cat 5 hurricane.

So all that sucked up three weeks right there! Whoohoo!

I’m doing better now, thanks for asking, but am having to catch up on all the regular-life business that got neglected, and continue the transition to school year activities.  (Example: This week, I’m going to REMEMBER THAT ORCHESTRA STARTED and actually bring my children!  That will be neat! Teachers love it when you do that.)

That’s all I’ve got time to say now.  Headed to Adoration this afternoon while a child is at PE, and as always I keep my readers in my prayers!  I will write soon, I think.

 

File:Flamencos andinos (Phoenicoparrus andinus), Laguna Cañapa, Bolivia, 2016-02-03, DD 63.JPG
You know who takes good photos? Diego Delso. That’s who.

PS: Let me just say that if you have the option of sending your child to a good Catholic school or a good Catholic homeschool? Do that.

 

Photo: Andean flamingos (Phoenicoparrus andinus) in the Cañapa lake, Bolivia. Diego Delso, Wikimedia Commons, License CC-BY-SA 4.0

What is this “Personal Relationship with Jesus” Business?

Twice in the past month men I know, good solid Catholic men who run circles around me in the holiness business, have mentioned in passing that they’re not so sure about this “Personal Relationship with Jesus” stuff.  Larry Peterson did it here, and Tom McDonald did it here.  Both articles are worth reading on their own merits.  These are not wishy-washy lukewarm Catholics.  These are men who have counted the cost of discipleship and have stepped up to pay it.

Both articles ran on Aleteia (which site I recommend — loads of good stuff), where Judy Landrieu Klein answered the question back in April with an unequivocal Yes: A “Personal Relationship with Jesus” is indeed an authentically Catholic concept.

Because the question is still being asked, I’d like to answer it as well.

File:Christ the Pantocrator by Jovan Zograf (1384).jpg
By Metropolitan Jovan Zograf [Public domain], via Wikimedia Commons

What kind of relationship do you have with a person?

To be human is to have a relationship of some nature with three divine Persons: God the Father, God the Son, and God the Holy Spirit.  One God, three Persons in God.

You might have an antagonistic relationship, a numb relationship, or a sorely neglected relationship, but you’ve got something.  To be Catholic is to acknowledge, even if you don’t realize you’re doing so, that God isn’t some vague cosmic force or a misty feeling or a set of good thoughts.  God is Personal, period.  You literally cannot be baptized without acknowledging the Personhood of God.

Persons, even when it’s a Divine Person and a human person, are made to have relationships with one another.  The question I think many Catholics struggle with is partly linguistic and partly practical: What should we call our relationship with God, and what should it be like?

Do Protestants own all the words?

Catholics used to be people who borrowed words shamelessly.  Need a word to describe what a “Church” is?  Hey, look, there’s a Greek word that we could use to get us started, grab it and run!  Large swathes of the Catechism are littered with words that Catholics picked up off the sidewalk and put to work in ways those words weren’t previously used.

Like the Greeks and Romans and even those pagans who lent us the word “Lent,” American Protestants have a few useful expressions of their own. The concept of a Meat-and-Three restaurant, not to mention Macaroni is a vegetable! come to mind, but we’ll stick to theology for today.  A “Personal Relationship with Jesus” is a phrase used heavily by American Evangelicals, sometimes beautifully and sometimes in ways that make you suddenly remember there was another county you needed to be in right now.

But they are words that, when used rightly, do in fact sum up Catholic spirituality.  They are words that we now find helpful, in this era when many Catholics do not believe in the doctrine of the Trinity. They are words that counteract the pseudo-spirituality that infects the Catholic Church and reduces the reality of the Incarnation to supposedly-edifying legend.

Where do I find this in Catholicism?

Q. Why did God make you?
A. God made me to know Him, to love Him, and to serve Him in this world, and to be happy with Him for ever in heaven.

May I recommend you purchase a copy of the old four-volume edition of Butler’s Lives of Saints?  The writings and lives of the martyrs and mystics are soaked through with the intensely personal nature of a well-formed relationship with God.

When we speak of knowing, loving, and serving God, we aren’t speaking of rendering obeisance to some distant overlord who wants us to pay tribute.  We are speaking of Someone who knows us entirely inside and out, and who wants to be known by us.  Someone who chose to suffer grievously that we might again be able to walk in the garden together.

The concept of a “Personal Relationship with Jesus” is specifically about owning the Incarnation.  Our Lord didn’t appear in the Heavens on His Throne and zap the world clean from a dignified distance.  He took on human flesh that we might eat with Him, and care for Him, and lay His body in a grave.  God seeks intimacy with us.

This is Catholicism.

Can poetic prayer be personal prayer?

It can be hard to say out loud the things we feel most deeply.

One of the hallmarks of the Catholic liturgy is that the Church gives us the words to express what we would say to God if only we knew how.

When we purchase a greeting card at the grocery store, we don’t have too much trouble with this concept.  We look through the racks until we find the right words for the occasion, the words that best fit the relationship between ourselves and the recipient and the event at hand.  Yes! That one says what I’d like to say!  When we receive a card, we are moved by the sentiments if we know they come from a loved one who is genuine in sharing the humor or well-wishes or tenderness of the ideas in the card.

(And likewise: Nothing is more off-putting than receiving a card from someone who most certainly does not share the sentiment printed on the cardstock.)

But we live in an age with very little poetry, and which often mocks the beauty of previous generations’ rhyme and meter and melody.  We can accept the idea that we might be truly expressing ourselves in the greeting card or when we sing along to a pop song on the radio, but somehow many of us have been deceived into believing that we our unworthy of higher art. We’ve been persuaded that too-beautiful words aren’t capable of being our words.

The Incarnation is Everything

The law of prayer is the law of belief, and if we pray the Our Father or the Glory Be convinced that somehow these are words too high for us, too mighty for us, we’ll come to disbelieve the Incarnation.

We’ll persuade ourselves that Bless us O Lord is the herald’s shout to Jesus on His Celestial Throne Who Can’t Be Bothered To Get Any Closer, not the simple few lines of people wishing to pause before eating to say a word of personal thanks to a Person who literally dwelt within our very bodies the last time we received Holy Communion.

This heresy is at the heart of our liturgical wars: It is it only “authentic” prayer if it’s folksy? Or is God so august that we must never approach the throne of grace with anything but fear and trembling?  It’s a false dichotomy.  In the liturgy I’m a child learning to say grown-up words.  God the Father wants to rear me for His Heavenly Kingdom; God the Holy Spirit breathes supernatural life into my feeble attempts at prayer; and the God the Son is both there at table for me to lay my head upon His breast and raised to the great high throne in majesty.

My relationship with Jesus is personal because Jesus is a Person.  I grow in that relationship the more completely I embrace the entirety of what Christ is. God humbled, God crucified, God glorified.  All of it.

 

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Colijn de Coter (fl. 1493-1506) [Public domain or CC0], via Wikimedia Commons

Related: Don’t miss Judy Landrieu Klein’s recent post: “Is God good all the time? Or only when we feel blessed?”

 

Today’s topic is important enough that I’ll be cross-posting it at Patheos as well.  Share from whichever venue you prefer.  Per my standard policy on blog posts, parish and diocesan publications have permission to reprint at no charge, please provide a link back to the original in your attribution.

Chastity in a Box? (with a Glimpse at YOU from Ascension Press)

Continuing with Book Week.  Box #2 raises a question that doesn’t get asked often enough: What part do chastity-education programs play in teaching teens (and grown-ups) about the right use of their bodies?

My thoughts follow, but first you should show know what was in the box:

YOU from Ascension Press.  I reviewed AP’s Theology of the Body for Teens: Middle School Edition some years ago, and liked it immensely.  A first glance at YOU is similarly positive.  It’s a much bigger and deeper program, and from everything I’m seeing among teens in the circles I run in (church-school-sports), YOU looks like a solid answer to a very serious need.

As I flipped through the books the other night, several things caught my eye:

  • The advice for how to teach teens is dead-on.
  • The parent booklet gets right to first things first.  It’s like they know they only have a paragraph to win us parents over.
  • The curriculum, as will the best Theology of the Body presentations, starts with the bigger picture, lays the essential groundwork on the dignity of the human person, and leads from there into a positive message about the goodness and appeal of chastity.
  • YOU is working off ideas that have been tested with teens over and again and found to work.  (Not surprising, given who the authors are.)

It’ll be a while before I get a chance to read the leader’s guide and parent guide (leader’s guide contains the full text of the student book) cover to cover, as well as watch the whole DVD series.  Thus I wanted to flag this series now, because I’ve got a very positive impression at first glance, and if you’re planning programs for your parish you might want to request your own review set rather than waiting on someone else’s opinion.

Where do ready-made chastity programs fit into the big picture?

If you phoned me this afternoon (please don’t) and asked me what I recommended for taking your generic typical-American-parish from zero to full-steam-ahead on teaching teens chastity, here’s what I’d recommend:

1. Start with a good parent-centered introduction to chastity, such as Family Honor’s Leading and Loving program.  There are lots of options for meeting formats, but (using L&L as an example) I strongly recommend investing the time and energy into spreading the program out over six weekly sessions rather than doing a single big-weekend event.  This gives you time for parents to get to know each other, to have time to talk with the leaders in detail, and to begin to form a small group atmosphere.  It lets parish leadership begin to identify the parents who are in the best position to help other parents.  It also gives lots of time for listening, and thus for learning where parents in your parish are coming from and what questions or difficulties they are having.

–> Make sure you’ve got the depth of back-up resources to assist parents with their concerns.  At a minimum: NFP instruction, good pastoral help with thorny marital irregularities, some resources for dealing with pornography, and access to support for parishioners grappling with same-sex attraction (personally or via a friend or family member’s situation) such as Courage. It’s no fair telling people they need to radically change their lives, then wishing them good luck and washing your hands.

2. When parents are ready to start sharing the message of chastity with their teens, do a parent-teen joint program.  There are any number of options, and many of them (Family Honor is an exception) assume parents won’t be present. Don’t go there.  You need the parents totally involved and on board.  Your six hours in front of an eighth grader are nothing compared to the influence of the parents.  Even if the program you select doesn’t call for parental presence, adapt it to make it a parent-teen program.

3. Keep working discipleship on all the parts of the Catholic faith.  Salvation isn’t about sex-ed alone.

Hint: Check out the Jesus is Lord program, which works for college students too.  Just sayin’.

4. Programs like YOU will have the most impact if you roll them out after you have a critical mass of parents who are actively seeking to foster chastity in the home, and a critical mass of parishioners and parish leaders who are disciples.

I’m not saying there is no fruit that comes from grabbing a random teenager who’s fully immersed in the wider culture and subjecting the child to a few weeks of Catholic teaching.  Good things can happen.  But the reality is that an hour of your life in alien country rarely makes you want to join the aliens, if you were heretofore perfectly happy back home in Depravityville.  More likely, you’ll go home thinking you met a bunch of crazy people and thank goodness you’ve escaped.

Making disciples is work.  YOU looks like it’s got loads of potential as a help in that work, which is why I mention it now.  But making disciples is long, slow, constant work.  There are no short cuts.

Related:  Registration for the Theology of the Body Congress (9/23-25/2016) is still open.

YOU by Ascension Press - Catholic Teen Chastity
Image courtesy of Ascension Press.

Six Things I Needed to Hear – In the Catholic Mom’s Prayer Companion

So this is what it’s like to be a devotional-writer:

I got home from Portland in the middle of the night East Coast time, wide awake because {Coffee + Jet Lag}.  But look! Things came in the mail for me!  No need to be bored.

Box #1 was a stack of these: The Catholic Mom’s Prayer Companion. It’s a collection of reusable devotionals for every day of the year, contributed by such a massive collection of Catholic writers that I think they were hard-pressed to find non-co-authors left for the endorsements.  (But they did find a few.)

So I got a beer and flipped through to find my entries, just to see what they looked like and all that.  One gets self-absorbed late at night.  There’s not an index-by-author, so I had to do a combination of trying to remember what days I wrote on and just flipping through.  Three lessons I learned:

1. Goodness gracious I can’t believe who else is in there!  A lot of the co-authors are people I know from the Catholic writing community, some of them famous, some of them up-and-coming.  At the risk of sounding cliche, when you’ve actually met and worked with so many interesting and talented and devoted Catholics? It’s a tremendous honor to be sharing a book with them.

(My favorite part of being involved with the Catholic Writers Guild?  Finding out who the new talent is before the rest of the world gets in on the secret.)

2. Editors are your friend.  When I wrote this post at Patheos, I was in the middle of overhauling a couple of my submissions for this book.  So let’s cut to the chase: We are all very, very glad that my first attempts at the feasts of St. Mary Magdalene and of the Immaculate Conception did not make it into the book.  The revised versions are far better.

3.  I have a predictable soul.  I think I found all my entries (Six? Did I count right?), and there was a consistent theme: The same things I was writing about a year ago are the things I needed to hear just this week.

–> Shout out to my brother-in-law: Why yes, I did get to be the person who wrote on the feast of St. Maximilian Kolbe.  I was stoked. But reader, if you want to know what I’ve been particularly thinking about the past two days, take a look at what I had to say on the feast of St. Rita.

Contents of Box #2 to be revealed in the next post.

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Cover art courtesy of CatholicMom.com and Ave Maria Press.

God’s One Weird Trick

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I learned three things from lectoring yesterday at my niece’s wedding, and a fourth I don’t want to forget.

The first is that the same old readings are never the same and never old.  First and second readings were the two most popular Catholic wedding choices going, Genesis and Corinthians.  You’ve heard them so many times you think you know them by heart (though you probably don’t).

But this time, standing before this couple, certain words pop out and resound and suddenly make sense in a way that almost feels like they were waiting all these millennia for the right two people to come along and make you say, “Aha! So that’s what this reading is about!”

It’s always like this when you pray the Scriptures, because you aren’t reading some old story, you are stepping into an interaction between the eternal and the pressing present.

Second: If you can only pray one prayer, try the Litany of Humility.  I’m not convinced it’s even necessary to pray the thing all that often, because it’s that powerful of a prayer.  Something that struck me as I was reading through the “Love is . .  .” series in Corinthians 13 is that all the different aspects of love are fruits of humility.  Thus the litany is a two-fer: You can quash your miserable ego and accidentally find yourself becoming a loving person into the bargain.

Try it.  You’ll hate it.  Until you don’t.

Thirdly, about that liturgy!  The Catholic liturgy is extraordinarily dense, and thus exquisitely suited for use by we the extraordinarily dense.  I could not help but notice how little anything at all depended on we the people present doing the work, other than that we show up and do it.  I don’t mean that it’s anything-goes for the humans: When we cooperate with God, making the effort to know what we’re doing and do it as well as we’re able, the liturgy is better.  It’s always better when you work with God rather than against or apart from Him.

I think because I was up there reading (which I only really do at family weddings and funerals), I was more conscious than usual of the part we humans bring to the Mass, and this allowed me to see how much we humans aren’t the ones bringing it.  God does the work, we cooperate.  The Catholic liturgy is in this way completely opposite of anything else.

And the fourth thing that’s so hard to get through thick human skulls:

Love never fails.

(1 Corinthians 13:8, for your  memory-verse purposes.)

That’s the one weird trick.

We try all the other things.  We go on and on and on about how we have to do all the other things, because the one thing needed just won’t cut it, quit being so pie-in-the-sky.

But of course, there is pie in the sky, which changes everything.  The Persons putting on that party know their business.  We dense ones have all these other methods for chasing after human happiness, and it turns out there’s just that one thing that always works.  Never fails.

So my feast of St. Lawrence* resolution is to try the one thing.

 

*Why yes, in keeping with the feast day, it was in fact a barbecue reception.

 

Popular Wedding Readings

Infographic courtesy of Together for Life

Wedding ring photo courtesy S.Mitch at French Wikipedia [CC BY-SA 2.5], via Wikimedia Commons.