13-16 Chapter Thirteen Crisis and Trauma As I (Karen) sat with my pastoral colleague, she told me how she had endured five miscarriages in the course of just a little more than a year. She helped me learn more about her grief and the silence she had kept as she continued to do her ministry. As I listened, it opened up my heart to a greater understanding of the depth of this trauma. Such traumatic situations and learning “opportunities” are common to pastors and CCMs across the country. As challenging as these traumatic moments are across our communities, they offer an opening for the church to bring Christlike healing. This chapter will address some very current situations and how we might be equipped to lead people out of the darkest of moments. Basic Understanding of Crisis and Trauma Let us take a moment to differentiate between the words crisis and trauma. For our purposes in this text, the word crisis will help us name what the acute situation is such as miscarriage, sexual assault, or financial loss. Trauma will be the long-term effects of the crisis event and how the situation affects our physical, emotional, relational, and spiritual well-being. Our depth of understanding of crisis and the resulting trauma is many times built out of our own life situations. Whenever I would be interviewing candidates for a particular ministry in the church, the most important question (in my mind) was to ask them what event in their lives helped them draw closer to God or the Christian community at such times. These questions always opened my eyes to their strengths and how they might fit best into our ministry. One particular time I was interviewing different people to be my assistant. There were two very qualified candidates, but when I asked this question to the person who was awarded the job, she told me the story of how her four-year-old was run over in front of the family’s house. At that point she was nearly six years out from the event and she was able to relay the event and how the church came to help the family over the weeks and years ahead. By her composure and capacity to tell her story, I knew this woman could walk alongside me when any crisis happened. Plus, I hope that our work together continued to offer her a depth of healing greater than she expected. Some theologians speak of three different orders of suffering. The first order is where things cannot be controlled such as grief, illness, and separation/divorce. The second order is caused by acts of human evil such as murder, violence, prejudice, and war. Now in recent years the third order of suffering is described as a type of despair and hopelessness that grabs people in the midst of the first- or second-order suffering and keeps them stuck in their pain, unable to move forward. Such things as a mass shooting can impose such powerlessness and PTSD. As the church we must continue to infuse the world with the gospel message of resurrection and help people rise up in the midst of pain. What I believe to be true is this: A crisis can crush, paralyze, anger, drive us to despair, or . . . it can propel us to greater visions of purpose and mission than we thought possible. A crisis provides us opportunity for great growth. Every experience is a teacher. Our greatest growth can happen when we embrace tough moments with gratitude and allow them to shape us into new creatures in Christ. As the caregivers and sojourners who walk alongside people through crisis and trauma, it is so helpful to have a degree of experience of similar pain in our own lives. One great mentor of mine always emphasized to me the importance of true empathy as she said, “We must reveal to heal.” I have passed along this sage advice to hundreds in their journey that they might have the courage to share their stories as they seek more complete healing. That is why people who are wounded healers are many times the best caregivers as they understand more fully the long-term trauma that a person might face. Many times, people see hope through the lives of those who have lived through similar situations and not only survived but thrived in the aftermath. Three Immediate Basics as You Respond to Any Crisis 1.​Pray for guidance, strength, and assurance that you might hear God’s voice. So many times, I have felt inadequate or fearful as I drive toward the situation. We absolutely must be grounded in God’s grace and love as we walk into any situation. 2.​Respond quickly. Once you know a crisis has occurred, respond immediately by calling your pastor (as a CCM) for direction or going to the scene yourself if you cannot reach the pastor. Do not be a lone ranger, but rather enlist others to help. 3.​Be the presence of Christ. Our job is not to offer expertise in any logistical way (although there are exceptions) but rather to offer spiritual care that is needed during the critical moments. Sometimes you do not need to say a word but by merely being present you may be sharing the most important gift. It is absolutely essential that our own theology as people of faith be well thought out. Probably most important, remember that crisis and trauma are not God’s will for our lives but rather the result of living in an imperfect world where bad things happen. God is with us through the crisis and helps us have our own moments of resurrecting up out of the trauma. As caregivers, it is essential to be able to assure people that God is with them, helping them to make it through the pain and then to eventually help them rise up into new creatures in Christ. What to say and do will become clearer as we go through a few different types of crisis noted in this chapter. More situations are noted in the participant workbook including anger, abuse, job search/financial care, grief, infidelity, and utilizing case studies for these. Taking time to visit with other CCMs and pastors about the different situations listed will help you feel more confident when you are given the “opportunity” to care. Cancer and/or Chronic Illness Talking Points/Information ​Love the physical part of you that carries the cancer or other chronic illness. ​Thoughtfully take care of your body through diet, exercise, and rest. ​Focus on treatment opportunities. ​Find joy within adversity when possible. ​Ask supporters to be with you where you are—whether in pain or as cheerleaders. Scriptures ​Psalm 121 ​Psalm 63:8 ​Isaiah 43:1-7 ​Lamentations 3:32 ​2 Corinthians 4:8 ​Philippians 4:13 ​Hebrews 12:2 ​James 5:13-15 ​1 Peter 5:7 Prayer Lord, you said that when we walk through the water, you will be with us; we are precious in your sight and you love me. In this time of health trial and adversity, I need to be aware of your presence more than ever. Lord, some days I feel hard-pressed on every side, but with you near I do not feel crushed. I am struck down at times, but not destroyed. When this disease makes me feel as if I don’t have any control, Lord, give me strength and courage, hold me in the palm of your hand, and give me peace. Amen. Suggested Reading and Resources ​Jesus Calling by Sarah Young ​Jesus Lives by Sarah Young ​The Will of God by Leslie Weatherhead ​What about Divine Healing? by Susan Sonnenday Vogel ​Cancer support groups ​Ongoing pastoral care and counseling opportunities from the church ​The American Cancer Society ​Caring Conversations (www.practicalbioethics.org) Divorce Talking Points/Information ​Your worth is not tied to your marital status. At your creation, God called you “very good.” ​Divorce is a painful split. ​Dating immediately after a divorce can stifle the healing you need, because you might try to find your healing in another person. ​You will need to eventually forgive, for your own sake. Forgiveness blesses you as you release the control your ex-spouse had over your feelings. ​Forgiving too soon can be hazardous to your healing. When you do forgive, you may decide to do it with your own ritual (for example, writing the word forgiveness on paper and burning it). ​Saying “I forgive you” to an ex-spouse often incites more anger and pain. ​If you are a parent, do not treat your kids, regardless of their ages, as your caregivers or best buddies. ​Make space for your kids (of all ages) to share their pain even if their pain causes you guilt or hurt. They need you. ​Teenage children need particular attention during divorce: they are more likely to behave in overly sexualized ways, adopt an eating disorder, or cut themselves. Scriptures ​Genesis 1:31 ​Luke 13:10-17 ​John 8:1-11 ​Romans 8:1 ​Philippians 3:12-15 ​1 John 4:7-20 ​Revelation 21:5 Prayer God of infinite love and understanding, pour out your healing spirit upon me as I make a new beginning. Where there is hurt or bitterness, grant healing of memories and the ability to put behind me the things that are past. Where feelings of despair or worthlessness flood in, please nurture a spirit of hope. Give me confidence that by your grace tomorrow can be better than yesterday. Heal my children and help me minister to them. I pray for other family and friends in Jesus Christ my Savior. Amen. Suggested Reading and Resources ​Radical Recovery: Transferring the Despair of Your Divorce into an Unexpected Good by Suzy Brown ​Divorce recovery groups for men, women, and children ​Marriage and family therapists Infertility, Miscarriage, and Stillbirth Talking Points/Information Regarding Infertility ​Today one in six couples (17 percent) is infertile. ​Infertile women have depression scores that are basically indistinguishable from those of women with cancer, heart disease, or hypertension. The psychological toll of infertility cannot be underestimated. ​Infertility is the inability to conceive after trying for twelve months. ​Primary infertility is not being able to have a live birth of your first child. Secondary infertility is inability to have a live birth of a child after previously having a child. ​Listen and allow the woman/couple time to share their feelings of pain. ​Connecting them with others who have had this experience is helpful. Suggested Reading -​Hannah’s Hope: Seeking God’s Heart in the Midst of Infertility, Miscarriage, and Adoption Loss by Jennifer Saake -​When Empty Arms Become a Heavy Burden: Encouragement for Couples Facing Infertility by Sandra Glahn and William Cutter -​The Infertility Companion: Hope and Help for Couples Facing Infertility by Sandra Glahn and William Cutter -​Empty Womb, Aching Heart: Hope and Help for Those Struggling with Infertility by Marlo Schlaesky -​Grace Like Scarlett: Grieving with Hope after Miscarriage and Loss by Adriel Booker Talking Points/Information Particular to Miscarriage ​Miscarriage is losing a fetus before it is able to survive independently, usually any time prior to twenty-eight weeks. ​Recognize that mothers and fathers may feel very similar pain and expressions of grief, but they may also have very different and what may seem like extreme emotions. ​Many times people grieve silently, remembering their miscarriage dates without saying a word to anyone. The due date may be a trigger for grief. ​A miscarriage will cause physical and hormonal changes that need to be respected. Scriptures ​Romans 8:24-25—Hope for what we do not yet have. ​Isaiah 40:31—Hope in the Lord will renew your strength. ​Matthew 5:4 (NRSV)—“Blessed are those who mourn, for they will be comforted.” ​1 Peter 5:7—Cast your care upon God that you may be restored by grace. ​Romans 12:12—Be patient and faithful. ​Jeremiah 29:11—God has a plan and a future for you. ​Philippians 4:6-7—Present your requests to God that you might have peace. ​2 Corinthians 1:3-4—God consoles us in our affliction. Prayer Lifegiving God, we come to you hurt and broken, trying to understand why this life that we had hoped to bring into this world is now gone from us. We only know that where there was sweet expectation, now there is bitter disappointment; where there was hope and excitement, there is a sense of failure and loss. We have seen how fragile life is and nothing can replace this life, this child, whom we have loved before seeing, before feeling it stirring in the woman. In our pain and confusion we look to you, Lord God, in whom no life is without meaning. Prepare my body and please bring to us the right doctors and modern miracles that we might create a child. Give us your compassion that we might live forward. In Christ’s name. Amen. Personal Story and Suggestions from Rev. Joy Dister-Dominguez Recently I came across a journal I used as a teenager outlining my dreams and goals. While most have changed, one has not: to have children. Two and a half years ago when my partner and I first began to struggle with unexplained infertility, I went through a process of grief, sadness, and shame. “Why me, God? Why us?” When our journey brought us to IVF after prayerful consideration I thought, “This will solve our problems.” Our first egg retrieval went well, although painfully, and soon after, we transferred the perfect embryo, and waited. At our six-week appointment we saw a strong heartbeat and were told we’d have less than a 5 percent chance of miscarriage. We were so happy; I cherished every moment, even though I had horrible morning sickness. I began to dream of our future with our baby. We entered our nine-week appointment, excited to see how our baby had grown. The next day we had plans to tell our parents; our hearts were bursting with joy. But I knew something was wrong when we didn’t see our baby right away on the sonogram. The look on the doctor’s face said it all: the baby vanished, gone. Shock, disbelief, anger, and grief took my breath away. The doctor and nurse left the room; I hugged my partner tight as I cried and wailed, and he cried with me in disbelief. The following days I had a D&C (dilation and curettage, a procedure to remove tissue), and I was numb with excruciating grief. I felt so much despair and hollowed out; our dreams of this little boy and our family were gone. Our parents grieved with us, a loss of a grandson and their dreams too. Yet, I knew that Jesus wept with us. I leaned on God to make it through each day, some days just to get out of bed. Years later, I still have my moments of deep despair. Months later we tried again, and months after that, again. Another round of IVF, more tries, other early miscarriages, and the grief continued to build. Someone said to me, “I don’t know how you do it.” I replied, “I have no other choice. I feel called to be a mother. We feel called to be parents.” I am preparing my body for the third round of IVF with the hope and prayer that this time will be different, and someday we’ll hold our baby. I’ve found safe, supportive friends to process this compounded grief, and I am intentional in self-care, especially on difficult days where I deeply grieve our babies who are with God. Information and Suggestions from Rev. Joy •​There can be a great deal of shame surrounding infertility, miscarriage, and stillbirth. •​It is your job as a pastor or CCM to have a basic understanding of these situations and respond accordingly. Create a safe environment for women or partners to talk without shame, judgment, and insensitive comments. It is important to honor the feelings people have while not trying to project assurances of the future. “Oh, just relax, it will happen” is painful to hear, rather than comforting. •​Pastors and CCMs should recommend women and partners to seek professional counseling, preferably from a psychologist who specializes in women’s mental health, or spiritual direction. When appropriate, suggest a physical burial with a token or perform a short service of remembrance. Miscarriage and stillbirths leave gaping holes emotionally and physically. The baby who was prayed for, and plans that were made get ripped away. Often family and friends do not know how to respond. Pastors and CCMs can respond with the ministry of presence: call and offer to show up with food, flowers, or gifts of remembrance. Do not offer cheap platitudes or try to make sense of the loss spiritually. A gentle reminder that God is present in their suffering, grieves with the loss of this baby, and is home their baby can help. Honor their feelings that will linger for days, months, and years. Remember sensitive dates such as Mother’s Day and Father’s Day, due dates, and loss dates, and help to honor the loss in special ways. Rape/Sexual Assault Talking Point/Information ​It is not your fault. ​You are made in the image of God. ​You are not alone. Scriptures ​Psalm 23—God is with you in the midst of the valley. ​Isaiah 43:1-5—Do not fear for I have redeemed you. ​Psalm 57:1—I take refuge in the shadow of your wings until the storms pass by. ​Psalm 71:20-21—You will revive and comfort me once again. ​Psalm 126:5-6—May those who sow in tears reap with shouts of joy. ​Psalm 143—Prayer for deliverance. ​Psalm 147:3—God heals the brokenhearted and binds up their wounds. ​John 4:4-24—God knows our stories and loves us beyond measure. ​Matthew 11:28-30—Jesus will give rest to the weary. ​Luke 13:10-17—The bent-over woman’s story as Jesus calls her out of the corner to speak. ​John 8:1-11—Be careful in interpreting the scripture that you do not believe what she is enduring is a sin but rather underline that God is with her, defending her. ​Romans 8—Nothing can separate us from the love of God. ​1 John 4—God is love and not about punishment. Prayer Lord, give me the grace to be honest—honest about my pain, honest about my feelings, honest about my anger, and honest about my questions. How could this have happened to me, God? Please lead me to trusted friends, mentors, and professionals who can help me process what has happened. Gracious God, help me be ever aware of your presence and remind me that I am a beloved child of God. In due time, Lord, help me rise up out of the ashes of this that I might help others regain their confidence and assurance that they are worthy. All this in Christ’s name. Amen. Suggested Reading ​Little Girl Lost: One Woman’s Journey beyond Rape by Leisha Joseph ​Survivor Care: What Religious Professionals Need to Know about Healing Trauma by Christy Gunter Sim Resources ​Metropolitan Organization to Counter Sexual Assault (MOCSA), www.mocsa.org; in Kansas City, 913-642-0233 or 816-531-0233 Domestic violence, emotional abuse, sexual manipulation, and assault are important areas for pastors and CCMs to consider as possible care scenarios. Healing from this kind of trauma takes years, and in many cases can shape a person’s life to either take on strength and purpose or it can cripple or paralyze the victim. It has been my personal experience that spiritual care is critical to a greater sense of healing. It is critical for the church to partner with mental health practitioners, local police, and medical caregivers who would be able to be part of the healing team. That being said, there is a high likelihood that violence and abuse will continue without being reported. Many victims may find themselves shamed or locked into a relationship that they do not feel free to report. It is important to note that many do not even understand that they are being preyed upon. The #MeToo movement has given victims a greater understanding of how prevalent this is and how to find their voice. To heal you must reveal. Yet again, most victims can find themselves in situations where people will either blame them or say words like consensual, which will shut down their voices again. There are so many great textbooks that can help you with facts and understanding in this regard. For our purposes, here is a condensed version of important points to consider as a spiritual guide: ​Make sure your theological understandings ensure grace and strength. When I, (Karen) finally revealed what was happening to me and the hell that my husband and I were living through, the first spiritual woman that I turned to offered me grace that felt like the balm of Gilead. She would listen deeply then offer me scriptures, daily devotional resources, a journal to write my prayers, and opportunities to bond with strong women of faith. Never before had I felt the arms of the church more fully or understood the gospel message of salvation more clearly. ​Because most victims feel depressed, unworthy, and ashamed, there is a need for counseling and medical assistance. For me, my weight fell down to eighty-seven pounds and I found myself compensating my pain by overworking and shutting some people out of my life. Be alert to symptoms that may need the help of other professionals. ​If you hear of a predator or domestic violence situation going on, how do you proceed? This question varies with every situation. The most important thing to remember is to offer support to the victim. Most people in these situations feel that they have lost their agency and capacity to make good decisions. If they need to leave the situation, offer them prayers of encouragement and if needed help them find safe places to go. If it is a situation that means daily contact with their abusers, help them visualize themselves taking control and staying clear of any vulnerable situations with the abuser. If you feel like they may be in highly dangerous situations, help them develop plans and perhaps seek protection orders from the local police. Also, many of us as pastors and CCMs are court-mandated reporters. Check with your state laws to understand what you are required by law to do. In all of these situations, listen for God’s voice as the spirit will speak to us. As a pastor or CCM, find a trusted counselor, pastor, or colleague to help you think through how you can best respond. These are not situations for “lone rangers.” Your care receiver will be eternally grateful if the situation is handled with great grace. Gracious Loving God, thank you for your watchful, loving Spirit. Please use us to bring peace that passes understanding through our ministries. All this to honor the Wonderful Counselor, Prince of Peace. Amen. Chapter Fourteen Mental Health Ministry “Whenever the spirit from God came on Saul, David would take up his lyre and play. Then relief would come to Saul; he would feel better, and the evil spirit would leave him.” —1 Samuel 16:23 NIV The scriptures make it clear to us that the biblical characters suffered with depression and anxiety. And although they called them “[evil] spirits . . . from God,” it is clear they were trying to find ways to relieve their suffering. Other scriptures include the laments of the psalmist along with the despair and depression of Job, Hagar, Naomi, and Judas. Sleepless anxiety is noted as Jacob in the scriptures wrestled with God night and day (one example from Genesis 32:22-32). As we seek to do our part to help struggling people with their mental health, the faith community can be key to eliminating the stigmas and misunderstandings wrapped around mental health. We must help our congregations understand that this is not brought on by God or by evil spirits nor is it a character flaw or spiritual weakness. Rather it is a disease process. If we get a physical wound or injury we are quick to go to an urgent care. That same kind of urgency to seek professional help must be encouraged when people need a counselor, psychiatrist, or both. Breaking the stigma can best be done through classes, sermons, and one-on-one care where shame and denial are identified. What We Know about Mental Illness ​In almost all cases, mental illness is a function of chemical imbalance plus genetic predisposition combined with environmental factors. ​MRI studies increasingly demonstrate that mental illness is best accounted for as differences in neurological functioning. ​One in five American adults experience a mental illness in a given year. ​Major mental illness reduced life expectancy by up to thirty years. ​Sixty percent of people with mental illness do not receive treatment, usually because of stigma. During the years of the Great Recession, suicide in the rural area where I (Karen) was raised was at a peak because of the unspoken shame and fear. The mental health struggles were many times dealt with by the guns or ropes in the closets of the farm or ranch families. Even recently with a world pandemic, there are cases of suicide born out of despair, exhaustion, and PTSD. As pastors and CCMs, we want to be of help with these situations. We may not be able to offer a full menu of mental health classes, but any size church can begin with creating connections with the mental health caregivers in your region who can brainstorm with you about how best to encourage care. No matter where you live, it can be challenging to find resources where you do not need to wait a week or more. That being said, it is essential for a church to create a list of resources ready to hand to congregants that will give them a starting point. This list of resources identifies trusted counseling and mental health services, local Alcoholics Anonymous/Narcotics Anonymous, safe shelters for abuse victims, national mental health hotlines, and food pantries, just to name a few. As faithful CCMs and pastors offering spiritual guidance, our role is important. We offer hope and encouragement through scriptures and prayer that God is with the suffering and loves them during this challenging time. Again, we should be making sure that our theology reflects grace without judgment. Key Scriptures to Consider ​Psalms 27; 31; 69; 71; 91; 138; 139; 143 ​Lamentations 3:21-24 ​Matthew 11:28-30 ​John 14:27 ​Philippians 3:13-15; 4:4-7, 13 Ways to Address the Stigma Regarding Mental Health ​Talk about mental illness, whenever you can and wherever you can. ​Regularly host groups, panels, and classes focused on mental health. ​Avoid using shaming words, such as crazy, psycho, insane, and so on. ​Don’t discriminate on the basis of mental illness for volunteer roles. ​Talk about the value of counseling and medicinal interventions. ​Collaborate with area clinicians on programming. ​Give staff and volunteers access to “mental health first aid” training. ​Find a mental health professional who can review your church’s worship experience. ​Take away guesswork by making as much of your ministry accessible online as possible. As Pastors and CCMs, It Is Helpful to Know the Differences among the Mental Health Clinicians ​Psychiatrists are medical doctors specializing in mental illness. In most contexts these providers focus on medicinal interventions. ​Psychologists are doctoral-level clinicians using primarily traditional talk therapy to treat clients. They may also administer advanced testing (ADHD, IQ, personality, etc.). ​Counselors/Therapists are masters-level clinicians who usually use traditional talk therapy to treat clients. They may also offer tools like EMDR, neurofeedback, TMS, and hypnotherapy. ​Substance Abuse Counselors are, in many states, able to obtain licensure without an advanced degree, though most states require a licensure exam. They use talk therapy and support to assist those in recovery. When helping a congregant choose a “Christian” counselor it is important to be aware of their theology, training methods, and values. Trained, trusted counselors should respect the diversity of clients, the goals of the client, and avoid imposing their own values, attitudes, and beliefs. All that being said, it is extremely important for you as a pastor or CCM to know the counselor has been vetted and know the person’s values align with your congregation. Try to eliminate barriers that would prevent people from getting counseling such as: ​cost, ​location, and ​too many/too few options. Prayer and meditation can be a hugely helpful tool for the struggling person. Daily meditation has been scientifically proven to increase the capacity of the brain to process at higher levels of reasoning. As you begin to care for someone, create a space of grace where they can feel accepted and heard. When they are ready, offer such meditation tools as the “Breath Prayer” that is noted in chapter 7. Another excellent method of praying is through journaling. Encourage them to acknowledge their pain followed by an acceptance of God’s love and light readily available to them. Breathing deep and releasing their pain eases physiological stress. The importance of daily prayer rituals cannot be overstated. As a pastor or CCM our task is to model, encourage, and provide tools to develop these disciplines of prayer. As you sit and care for those who are struggling mentally, the pastor or CCM must be clear (yet compassionate) about their own boundaries. For instance, be definite about when, where, and how long you will meet with this person. Do not overcommit or give your personal communication information too quickly. Be cautious and wise about the use of touch: it can be healing and comforting or confusing, hurtful, and unwelcome. All of these basic guidelines model for the person how to set their own healthy boundaries. One great resource that you might have on your shelf is a book titled The Depression Cure: The Six-Step Program to Beat Depression without Drugs by Stephen Ilardi, PhD (Da Capo Press). This text is a great one to offer a class for your community. It highlights Therapeutic Lifestyle Changes (TLC) that include diet, exercise, light (sunshine or otherwise), socialization, sleep, and finding healthy activities to counter rumination patterns. Even as we teach the TLC method and offer encouragement through spiritual methods, we must always be aware that a care plan for mental health should include mental health professionals. The church is most effective in mental health ministry when we promote the fullness of care. Anxiety Anxiety has been found to be as dangerous as depression. Thus it is important to be aware of a few of the symptoms: ​Excessive worrying ​Panic, fear, and restlessness ​Sleep problems ​Not being able to stay calm or still ​Cold, sweaty, numb, or tingling hands or feet ​Shortness of breath ​Heart palpitations ​Dry mouth ​Nausea If you note these symptoms, do not assume that you can help a person without more professional help. Address the possibility of seeking more help with the person. Also, remember these points: ​Anxiety can be contagious and can hijack your ability to provide good care. Manage your own anxiety by taking a deep breath and controlling your tone of speech, pace, response, and follow-up questions or comments. ​Stop to pray. This can break the cycle of anger, self-pity, or indecision that may be getting in the way of progress. Remember, you cannot control the other person’s response or the outcome. ​You are in control of the session’s length. Generally, at the onset, tell the person you are meeting with that you have set aside a certain amount of time, perhaps an hour. The greater clarity you can give, the better it usually is. Setting boundaries in space (a quiet, safe place) and time (decided ahead of time) gives people a sense of structure and will help them manage their own anxiety better. ​Allow yourself grace when dealing with complex or emotionally challenging situations. Remember, when we get down in the dirt with people as Jesus did with the woman in John 8, we can find ourselves in difficult circumstances. Do not be discouraged. Find a pastor, colleague, supervisor, or counselor to help you process your feelings. Offer Comfort The scriptures tell us, “Comfort, comfort my people!” (Isaiah 40:1). Always offer a next step for those who come to see you, even if it is just seeing them in worship next week. Offer weekly check-ins with good boundaries. Who else on your team would offer helpful compassionate support? Are there courses that would help them find healthy socialization or greater understanding of their situation? Are there ways that they can serve others to find a renewed sense of purpose? They have come to you, spilled their story, and offered you a part of their life that perhaps no one else has ever heard. You are acting on behalf of Christ and the church. What would Christ do for this lamb? Helpful scriptures include: ​Proverbs 12:25 ​Psalm 46:10 ​Psalm 91 ​Isaiah 43:1-5 ​1 Peter 5:7 One prayer tool you can share is a simple ABC Prayer ​“A” is acknowledge how you are feeling, without judgment. ​“B” is being aware of your breath. Breathing in peace, exhale your pain. ​“C” is choosing to be full of love, light, grace, peace, and joy. Suicide The statistics are clear: suicide is on the rise in the United States, especially among some demographics. According to the National Institute of Mental Health, the suicide rate increased 31 percent from 2001 to 2017. Increased rates of suicide are especially seen in younger people but also in older males (Statistics from the National Institute of Mental Health, January 2021) . As church care providers we must understand our roles to address suicidality: ​Develop a relationship with crisis resources in your community such as mental health centers, the local police, EMT services, fire department, and emergency rooms. ​Remember you are not equipped to be a police officer, an EMT, or an emergency room physician. ​Don’t let the threat of suicide be a reason for violating boundaries. -​Case study: You receive a call at midnight from a person who is suicidal. What should a CCM do? ​Develop guidelines your staff and volunteers can use and train them in their use, for example, knowing when to call 911. ​Avoid the use of euphemisms and be direct and clear if you suspect someone might be suicidal. If you suspect someone is disingenuous in their threat, it is crucial to remain direct and follow the protocol. This communicates that you are taking their words seriously. ​Don’t leave a suicidal person alone until you are sure they are safe. ​Make it OK to talk about. Ask every time if necessary if they have a plan or any intention of ending their life. It is essential that we are alert for suicidal warning signs: ​Talk about wanting to die or kill oneself ​Looking for a way to kill oneself, such as searching online or buying a gun ​Talk about feeling hopeless or having no reason to live ​Talk about being a burden to others ​Sudden unexplained recovery of depressive symptoms or a sudden positive outlook ​Sleeping too little or too much ​Withdrawal or feeling isolated ​Displaying extreme mood swings ​Acting anxious or agitated, behaving recklessly Responding to a Suicide How do we immediately respond as Christian caregivers when a suicide happens? When a suicide happens, Jesus (in the form of you) must show up and the quicker, the better. Pray yourself up: Gracious, loving God, this feels like the worst situation for this family and I know you have called me to be with them. Though I may feel fearful and inadequate, please bring to me a sense of peace, compassion, and strength that I can help the family through these moments. Help me to listen to your spirit as I search for the right words. Let the peace of Christ be with us as we move through this day. All this in the name of our healer, Jesus the Christ. Amen. If possible, take along another pastor or CCM. In the situation of suicide there is likely to be many people who will need one-on-one care. This is not the time to be a lone ranger! Once you arrive, there may be people who are clustered in groups and others who need their space. Be cognizant of the people around you; even first responders may need you to offer a prayer for them. We remember that for Jesus, getting down in the dirt was his way of helping people live through the crisis. With a suicide that may mean lying down on the floor with people or getting on your knees beside them. I remember when Joe took his life, I arrived at the house very shortly after the death and found Christine literally crying prostrate on the floor. At that point, I, along with other caregivers, got down on the floor with her. As if by osmosis, she eventually found the strength to sit up on the floor and then onto the sofa. Other times when people are in a chair, I have knelt down beside them. Most every time, I have allowed them to cry on my shoulder or through an embrace. Again, allow God to lead you that you might do what is needed as you observe good, honoring boundaries while addressing the crisis of the moment. It is normal for a family to test their theology with questions such as, “Why would God allow this? Where was God when Joe needed him?” It is at that point that the caregiver must respond clearly, yet tenderly. My standard answer for this question is that God was with Joe in the moment trying to get through to him, but because Joe’s mind was not clear, even God could not get through. Another common question is, “Do you think he (or she) is in hell?” This has long been a theological question that is still debated today depending on your beliefs. The United Methodist belief on suicide reads: We believe that suicide is not the way a human life should end. Often suicide is the result of untreated depression, or untreated pain and suffering. The Church has an obligation to see that all persons have access to needed pastoral and medical care and therapy in those circumstances that lead to loss of self-worth, suicidal despair, and/or the desire to seek physician-assisted suicide. We encourage the Church to provide education to address the biblical, theological, social, and ethical issues related to death and dying, including suicide. . . . A Christian perspective on suicide begins with an affirmation of faith that nothing, including suicide, separates us from the love of God (Romans 8:38-39). Therefore, we deplore the condemnation of people who complete suicide, and we consider unjust the stigma that so often falls on surviving family and friends.1 Of course, the big question of “why” did this happen will continue to be asked maybe even for months or years after the event. There will be lots of derivatives of this question: ​Why didn’t he/she talk to me? ​Why did he/she do this to the family? ​Why didn’t I see this coming? It is so important to allow enough time for people to process this event with you and others so they will hopefully find some peace in their souls. It is important for you to assure them that this is no one’s fault. For Christine, Joe’s mind was not clear, she had done all that she could, and it was not her fault. In the moment of crisis be clear that bad things happen to good people. A space of grace is essential—with no judgement . . . only grace. From the very beginning it is important to use language that will not cause more harm. For instance, I never use the phrase “committed suicide” because theologically we “commit” sin and we certainly do not want the family to believe that the person has committed a sin (some may say murder). Rather say, “took his life,” “completed” suicide, or “suicided.” My personal choice is “completed suicide” because it helps people see that there is an important choice of language that I am making and many times they will ask why I say “completed” instead of “committed.” This question offers a great opportunity for a theological conversation. In those early moments of crisis, whoever has found the body may need extra care. This experience can cause long-term trauma. For you to be able to help the person learn to pray and release this memory is critical. Scripture can be helpful. Some helpful examples include 1 Corinthians 15:44, 49-57 and 2 Corinthians 4:-12, 17-18; 5:1-3. These scriptures can help us reframe to a place of hope as we remember that there is a spiritual body for us. As a caregiver, you may also have seen the body (and perhaps anointed the body) and you may need to seek your own prayer partner and counselor to help you process what you have seen. Singing a familiar song can be helpful to calm the intensity of the situation. For Christine, we sang “Great is Thy Faithfulness.” She said the following day she chose a different song. Music can be a powerful source of strength and peace in the midst of great pain, shock, and fear. Like any drastic crisis, the complexity of suicide requires a team effort. To have CCMs who are checking in on the family is so important. The day Joe died, we immediately called in two CCMs who remained faithful caregivers for Christine. If a multitude of people come to the house, it is good at some point to call everyone into a circle to help them reclaim their faith and be assured that the person is with God. Very often families go through a moment when they feel shame about the event. As the spiritual leader, it is important that you help them understand it is not their fault and help them process the importance of speaking the truth about the situation. Those who have tried to hide the truth tend to take on a cloak of shame that disallows them from helping others and releasing their own pain. One family who lost their daughter to suicide immediately went to that place of hiding the truth, but when we began to talk about how sharing the truth might help others, they began to change their mind. Their daughter had been sexually assaulted as a sophomore in high school and she did not tell anyone until she began to experience severe depression. She eventually completed suicide her freshman year in college. What the family found was that they were able to encourage people who had been sexually assaulted and those who might be fighting depression. Again, sit with people during these moments so you can help them walk through their emotions. Besides pastoral care, long-term professional counseling is essential for the family of those who have completed suicide. As a pastor or CCM, encourage the person to seek out a counselor. You may also want a counselor to come to a grief group so the victims can begin to feel safe and familiar with the counselor. A special grief group for suicide victims can offer immeasurable help. Key Strategies for Such a Specific Grief Group Some specific strategies to keep in mind include: ​Finding the right facilitator for such a group is key. That person must have a well-thought-out theology. Although not essential, some leaders who have lived through such an event can embody hope to the participants. ​Encourage the participants to talk about their feelings and fears. ​Help them to understand the church’s stance on suicide. ​Provide scriptures that will help them remember biblical characters who struggled with depression or anxiety, with some of them completing suicide. Such people as Naomi, Hagar, Moses, Samson, Job, Jonah, and Judas will provide them great examples. ​When people are able to concentrate, provide books and curriculum that will give them words for what they are feeling. A skilled group facilitator can offer a thoughtful outline about a chapter of a book or an article that will help spark good conversation. That being said, the group discussion may need to go in another direction. ​Be alert for those in the group who may not have spoken. Gently invite them to express their thoughts and make sure that you speak with them before they leave the group. ​Other details to provide are tissues, name tags, and names of community resources such as mental health facilities. Remembering birthdays, date of death, and important holidays is an important way for the group to offer support to one another. Assessing Your Community 1.​What are the primary mental health issues in your community? 2.​Who is most at risk? 3.​What community collaboration needs to happen? 4.​What steps do you need to take to establish a group to address a mental health issue? Chapter Fifteen Recovery Ministry Never before in the history of humankind have we faced such a drastic need for recovery care. As of August 2019, USA Today reported that twenty-one million Americans struggle with substance addictions and that only one in ten of those addicted will receive treatment. The U.S. Surgeon General said that one in seven Americans will face substance abuse addiction. No doubt, every one of us can prayerfully say a name of someone close to us who is struggling. Gracious healing God, we remember our family and friends who are in recovery or need to be. Thank you for your presence with them. Please help us to be there for them and to provide encouragement. All this in our Savior’s name. Amen. Much of what we will be encouraging you to consider regarding recovery we have learned from CCMs and pastors who have dedicated much of their ministry to recovery because they have walked the walk. Like most churches that start a recovery ministry, Resurrection had an AA group that met twice a week down the far hall right beside a door to the outside so they could come and go without people seeing them. Just by this very action of room assignment we were perpetuating their shame. Most addicts do not want anything to do with the religious community because of the shame and secrets they are carrying. They associate judgment with the church instead of grace. So how do we create a recovery ministry where people can experience the true power of grace? First and foremost, like other ministries we need champions who understand from their own lives what it means to have a church family and a savior in their journey of recovery. Pastor Tom Langhofer came to me early in his recovery. At that point he was a layperson who wanted to get involved with our care ministries. I asked him to observe and engage with our new, fledgling recovery ministry. For seven years, Tom came and helped as he could with the ministry. It became his passion. As Tom lived into his own recovery I encouraged him to take the CCM training. Then as the years went by I encouraged him to become a pastor. Tom gave up a very lucrative career in real estate to become a full-time recovery pastor. He is just one of many CCMs who eventually became pastors. Essential Guidelines for a Recovery Ministry ​Find the right people who will draw others into the ministry: people who are willing to be vulnerable and tell their story to others. This may take time and several asks before they are willing to go public with their stories. Once they have an example like Tom, who they see is working on his recovery every day in the church, they are more likely to take the first step. ​Partner more visibly with your community AA and NA groups. Ask them how you can help them build their programs. ​If you are in a large town or city create a community advisory group that meets quarterly to brainstorm about how to tackle the addiction problems of your community. Branch out and invite other groups to be part of your recovery efforts. Invite local counselors, high school administrators, local police, rehab clinicians, hospitals, or any other local entity that seeks to give support to the individuals and families seeking recovery. Linking arms with others in your community gives your program credibility and greater visibility. ​Create a Recovery Night if you are able. Provide a meal where participants can fellowship and connect. One of the key factors for addicts can be a sense of loneliness. They think they are the only ones who are living in this hell. When they share a meal with others and begin to share their journeys, barriers begin to break down. A sense of belonging to a group that accepts them is such a gift! ​Instead of having a sermon or worship service at your recovery meetings, consider having one person give a meaningful witness or have a panel discussion where multiple people are sharing their stories. ​Search out or create your own recovery ministry curriculum. The Life Recovery Program is one option. ​Small group work is essential for Recovery Night. You may begin with a single group that includes everyone. At some point you may see a need to create groups that address the specific needs of teen addicts, sex/porn addiction, or family groups. Each one of these groups will need someone who can relate to the attendees. The brave souls who attend will begin to share and grow together into a new person in Christ. ​Marketing for your recovery ministry is essential. The usual methods of fliers and bulletin inserts are a first step. You might place such fliers in public places such as the local coffee shop, hospital, counselors’ offices, or high school websites. If you have a website, make sure you list it as one of the options that your church is offering. A short video of someone inviting people to come can be highly effective. ​Remember there is a need for the person to have the will to recover. The addict’s ownership of the problem and intention to begin recovery has to come first. As a family or friend, your personal journey needs to be addressed by groups such as Al-Anon. ​The addiction may be the result of an emotional wound or PTSD that may need to be addressed with long-term counseling. Relevant Scripture Verses to Help You with the Care of the Addicted ​Matthew 11:28-30 (NRSV)—“Come to me, all you that are weary and are carrying heavy burdens, and I will give you rest. Take my yoke upon you, and learn from me; for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light.” ​Romans 8:26, 37-38 (NRSV)—“Likewise the Spirit helps us in our weakness; for we do not know how to pray as we ought, but that very Spirit intercedes with sighs too deep for words. . . . In all these things we are more than conquerors through him who loved us.” ​Romans 7:15-20—These verses are impactful for those struggling with addiction while desiring to do good. ​Romans 12:1—Offer your body as a living sacrifice. ​Lamentations 3:40—Examine our ways and return to God’s path for us. ​James 4:10—Good will lift you up. ​1 John 1:9—God will forgive us and purify us. ​1 John 5:14-15—God hears us when we ask. ​Philippians 3:12-16—Forget what is behind and press forward. Suggested Reading ​Addict in the Family: Stories of Loss, Hope and Recovery by Beverly Conyers ​Codependent No More: How to Stop Controlling Others and Start Caring for Yourself by Melody Beattie ​The Alcoholics Anonymous Big Book by AA Services Melissa’s Sidebar On September 30, 2019, I got the call I’d been dreading for fifteen years. “Melissa, it’s Mama. Brandon—he didn’t make it this time.” The room spun as I fell down in shock, mouth open, and I started dry heaving as the news set in. My brother had died of an overdose. For seventeen long years he struggled with the disease of addiction that started with a sports injury and too many prescription pills. Cut to three months later when I received an email from a fellow pastor in town. A “generous” family had decided to bestow the Christmas gift of heat to one lucky family, no strings attached! The email went on to say that they wanted to make sure that they were paying for someone’s bills who actually deserved it—you know, not a drinker, smoker, or druggie. My grief turned to rage. Brandon would have deserved heat in the bleak midwinter, regardless of whether or not he was using at the time, and I still can’t get over the flippant way this pastor called folks who have the disease of addiction “druggies.” Pastors: language matters. When we use words like that to describe an actual human being made in the image of God, we reduce a person to their struggle. Brandon was so much more than his struggle. He was sweet, playful, and full of pranks. His sense of humor, laughter, and smile were infectious, and everyone who knew him loved him. He was kind of shy but would fill the silence with an unexpected zinger that made everyone in the room laugh. Brandon spent hours every day playing in the woods as a boy; and as he grew, he came to love fishing out on our great-grandparents’ land. On rainy days, when we couldn’t play outside, we would find him constructing elaborate forts out of pillows, blankets, string, and any other household items he could find. He loved going to the lake, especially around the Fourth of July, where he would spend the whole day popping fireworks with friends and family. Brandon was a history buff, skilled welder, and an artist at heart. But no one who saw him on the side of the road begging would ever know that, and it pains me to say that very few, if any, churches in my hometown knew his gifts. Many knew his struggle. Ministry leaders, I beg you to have compassion and mercy on the millions of people struggling with addictions of all sorts. For each person struggling with addiction, there is also a web of people additionally affected by it. I urge you to consider care ministry for friends and family of loved ones who may have lost their lives, continue to struggle, or remain alienated. Often, family members must define very difficult boundaries with their loved ones in order to remain healthy and whole, while not enabling destructive behavior. Sometimes, family cannot be family, no matter how much we want to. In these cases, I dream of a world in which the church can be the surrogate family to those struggling with addiction. Chapter Sixteen Communal Trauma All who believed were together and had all things in common; they would sell their possessions and goods and distribute the proceeds to all, as any had need. —Acts 2:44-45 (NRSV) Since the beginning of the church, Christians have recognized the need to care for one another to “all, as any had need.” How we extend care during a natural disaster, a pandemic, post–mass shootings, or a financial disaster must be considered a team effort. That team is most effective when it involves the whole community and perhaps even extends out into a state or national effort. As I (Karen) write this, we are in the tenth week of social distancing because of COVID-19, the first major global pandemic for the world since 1918. As the churches have locally addressed the needs of their people and the national church bodies have responded, there is much to consider. Humanity has been thrust into change that has happened sometimes by the hour. No matter what type of communal disaster, there are some fundamental, creative ways that the church can immediately respond. For our purposes we will divide our response into three categories: ​immediate response within the first twenty-four hours, ​possible responses through the trauma, and ​long-term changes. Immediate Responses Whether it be a natural disaster such as a hurricane, tornado, flooding, earthquake, or large-scale fires, the key to all of this is the way we as the shepherds respond immediately. The same holds true for pandemics, shootings, financial disaster, and national disaster. As a child in our small country church, I can remember the response of the church after a major storm came through with hail and tornado touchdowns that decimated our crops and our farm in particular. I remember the pastor and other volunteers immediately calling on us and offering help with cleanup, meals, and emotional support. Over the years, our farm, along with others, suffered through years of drought, more hailstorms, and bankruptcies. What do the people need in such times? ​Again, it may seem obvious, but call or go immediately to the scene if possible. In situations such as a pandemic your phone call may be the only way you have to respond. You are a first responder as a pastor and CCM. You represent the presence of Christ. ​Listen to the stories of how people experienced the acute situation. Allow them to express their emotions. If they need a shoulder to cry on, be there for them. These are our people and to help them through their grief, pain, and fear is absolutely a place where the church can offer the light and hope of Christ. ​Attend to any obvious physical needs such as water, food, hygiene, and sheltering needs. ​Offer a very brief word of scripture (this is not the time to preach) and let them know you will be there with them as they go through this situation. ​Pray for their comfort, strength, assurance, and peace. ​Before you leave or hang up, let them know how the church will be responding to them the next day or throughout. On a Palm Sunday, some of our church members suffered from a hate crime shooting. Two of us were at the hospital immediately to offer care. Upon leaving the hospital, we were able to offer next steps of gathering at the affected family’s home later that evening with anyone else that they’d like to invite. That evening, they had invited their closest friends to also give them support. Our teamwork began to expand as we considered their needs throughout the week and months ahead. The main family members were connected with at least one CCM who could connect with them specifically throughout the week. Because of the situation, the team realized that there was underlying racism and political divides that were surfacing. The challenges of white supremacy, gun control, and discrimination were some of the issues. Moving through the Trauma Within twenty-four hours the church’s strategy will begin to emerge. Remember: it is not the job of the people living through the crisis to call the church and ask for help. If you wait for people to ask it is a formula for failure. As a church we must be the ones reaching out. You may try some things that may not work and that is OK. Keep being creative as a team for whatever you think is needed. Remember how Jesus kept asking Peter in John 21 the same question, “Do you love me?” And Peter would respond, “You know I do, Lord.” And Christ would remind him, “Then feed my lambs” or “Take care of my lambs.” As an individual, family, community, or nation moves through a trauma the church needs to be nimble, ready to adapt to a changing situation. Items to consider: ​Monitor and abide by local, state, and national guidelines. Look to your denominational leaders for resources, financial assistance, and first responders. ​Communicate to your congregation so they understand why certain decisions are being made. Pastors and CCMs should be checking in regularly so that they communicate the same message to the congregation. ​Ongoing fear, anxiety, grief, and financial need can be addressed with regular check-ins from pastors and CCMs. Depending on the congregation, the church community may expect the pastor to begin this process, but it is the work of the team to be able to multiply the support efforts. ​Create trauma therapy programs, collaborating with mental health professionals so that both emotional and spiritual care can be conjoined for the recovery of both individuals and families, as well as communities. Many times, people are hesitant to reach out for mental health care. At moments when there is communal trauma the church may offer an initial pathway for people to move past their shame or stigmas about obtaining mental health care. ​Weekly worship is one way to name and remember how God is faithful through pain and disasters. As emphasized previously, an understanding of how God works in the world is so important. God gives us the great gift of choice and has set in place a world that may experience natural disasters. Thus people have found themselves on a beach when a tsunami has occurred. God allowed them the choice to go to the beach. Then the earthquake occurred in the ocean, which caused the tsunami. Emphasize that God walks alongside us no matter what happens. God weeps with us during these challenging situations. ​A sermon series or at least one sermon to address the situation should be considered. People may need to think through the big “Why?” question, or consider how Christian hope extends beyond the current situation. ​Care classes or groups may need to be created. In the case of a pandemic or financial crisis there may be a need for different varieties of prayer and meditation classes. Are there ways to help people with their job searches in the middle of a financial crisis? ​Is there a need for food and water (both immediately and ongoing)? Open your church and your kitchen to organize the ongoing need. ​If there is a need for immediate funerals, guide the family(s) and work as a team. During the pandemic, when funerals have not been happening in the usual way, be creative. Some churches provided Zoom or Facebook Live services while following social distancing rules. If a graveside service is allowed, other support can be experienced as congregants drive by or sit in the parking lot in their cars. ​In some situations, a celebration of life can be planned with the person who is terminal and can actually be provided before the person dies. If there can be no service in the sanctuary, create other ways to celebrate such as through a Zoom service. ​Utilize existing volunteers to provide for new needs such as face-masks (pandemic), sandbags (flooding), or volunteer construction crews. Long-Term Changes During and after any major disaster, the church will want to evaluate how they responded and if there might be any long-term changes that may be needed. The evaluation questions might include: ​How do you offer worship? ​How was follow-up created? ​How was spiritual and emotional care offered? ​How was financial care boosted? ​How was safe housing provided? ​How was educational help provided? ​How were collaborative efforts offered and received? ​How was food insecurity addressed? During a time of disaster, a church who tries to work alone will have less impact than a group of churches or community organizations. Collaboration and team-building skills are key to the recovery of a community. It probably states the obvious, but when a church runs toward a communal disaster and offers Christlike care, it can be an amazing time of building the church as we walk beside all of those who are in need. Answering Christ’s call to “feed his lambs” can help us become the church of the future. Questions to Consider 1.​What has your church learned through any communal challenges? 2.​Are you prepared for communal disasters? 3.​How can your denomination help? 4.​Are you establishing collaborative work throughout your community?