January 2025

Introduction The journey through mental illness is often marked by profound questions, not just of health but of meaning, hope, and resilience. Within the Catholic tradition, the intersection of suffering, faith, and pastoral care offers a deeply rooted perspective that can guide individuals navigating these challenges. Father Francis Clooney, a Catholic priest and scholar of Comparative Theology at Harvard University, reflects on the role of suffering in the Catholic worldview, the importance of community in embodying Christ’s love, and the example of saints who found holiness amidst mental health struggles. Join Imran in this interview as he asks three questions related to pastoral care in cases of mental illness:  From a Catholic perspective, how is suffering understood in light of the Bible’s teachings, especially when it relates to mental illness?  How can Catholic communities better understand and support individuals with mental illnesses in a way that reflects Christ’s love and compassion? Are there saints or figures within Catholic tradition who exemplify how to embrace suffering, particularly in the context of mental health struggles? Understanding Suffering Through the Bible The Bible does not shy away from the reality of suffering. From Adam and Eve’s exile to the trials of Job and the crucifixion of Christ, suffering is portrayed as an intrinsic part of the human condition. Father Clooney explains that the Bible neither romanticizes nor moralizes suffering. Instead, it reflects the complexity of life in a fallen world where “bad things happen to good people.” This realism is particularly significant when understanding mental illness. The story of Job is a cornerstone in this narrative. Despite losing everything—wealth, family, and health—Job steadfastly refuses to curse God or accept that his suffering is a punishment for wrongdoing. Instead, he demands an encounter with God, seeking answers to his anguish. When God finally appears, Job receives mysterious instruction: “You have no idea how the universe works,” which emphasizes trust over understanding. Father Clooney highlights that this trust—a belief in the presence of God even amidst incomprehensible suffering—is a central message for those grappling with mental illness. It reminds them that their suffering does not define their worth and that God’s compassion transcends human understanding. Fostering Christ’s Love in Catholic Communities Mental illness often isolates individuals from their communities, compounding their pain. In biblical accounts, physical and mental ailments frequently alienate sufferers such as lepers and the possessed. Jesus’ response to these individuals is radical: he not only heals them but restores them to their communities. For example, in the story of the Gerasene demoniac, Jesus’ healing power not only frees the man from his torment but also reintegrates him into his family and society. Father Clooney calls Catholic communities to reflect on this restorative love. He emphasizes that parishes should be places of radical inclusion, where no one is turned away due to their struggles. Rituals such as the Eucharist embody this inclusivity, welcoming all who seek communion with Christ. Sacraments like Reconciliation and Anointing of the Sick also provide spaces for healing. In Reconciliation, individuals can unburden themselves, sharing their struggles in a confidential and compassionate setting. Similarly, the Anointing of the Sick offers both physical and emotional solace, affirming the dignity of those who suffer. Moreover, many parishes host support groups, counseling services, and outreach programs for those with mental illnesses. These efforts signal that the Church recognizes mental health as a vital component of overall well-being. Beyond formal programs, Father Clooney reminds us of the importance of simple gestures—a kind word, an open ear, or an invitation to share a meal. Such acts mirror Christ’s ministry, which often began with meeting people where they were and extending love without condition. Saints as Models of Resilience and Holiness Throughout Catholic history, saints grapple with suffering, including struggles with mental health. Their stories offer hope and inspiration to those who feel burdened by their challenges. Father Clooney shares several examples: St. Dymphna: Known as the patron saint of mental illness, St. Dymphna’s story is one of enduring love amidst suffering. When her father’s mental instability led to tragic consequences, her unwavering faith and compassion became a beacon for those facing similar trials. St. Benedict Joseph Labre: Labeled by some as “dysfunctional” due to his erratic behavior, St. Benedict was repeatedly turned away from monasteries. Despite this, his deep spirituality shone through, and he is now remembered as a saint who found God amidst personal turmoil. St. Therese of Lisieux: Often called the “Little Flower,” St. Therese experienced profound sensitivity and depression, particularly as she faced the physical decline brought on by tuberculosis. Yet, her “Little Way”—finding God in small, everyday acts—offers a path to holiness for those battling inner struggles. St. John of God: Despite living on the streets and battling personal demons, St. John of God’s compassion for the marginalized transformed him into a model of Christ-like love. His legacy underscores that mental illness does not preclude one from a life of profound service and sanctity. These saints remind us that suffering, while deeply challenging, can also be transformative. It can deepen empathy, strengthen faith, and inspire acts of love that ripple outward into the world.  A Call to Action and Hope For those navigating mental illness, the Catholic perspective offers profound hope. It acknowledges the pain and complexity of their experience while affirming their inherent dignity and worth. Communities of faith have a critical role to play in embodying Christ’s love, creating spaces where the suffering are not merely tolerated but cherished and supported. Father Clooney’s reflections also challenge individuals and communities to embrace the mystery of suffering. While answers may remain elusive, the assurance of God’s presence and the support of a compassionate community can provide solace. For those seeking inspiration, the lives of saints offer a testament to the possibility of finding grace and purpose amidst even the darkest trials. Ultimately, pastoral care in cases of mental illness is not just about addressing immediate needs but about affirming the truth that every person, regardless of their struggles, is beloved

Holistic Understanding of Bipolar Depression Introduction Looking for a holistic understanding of bipolar depression? You’ve come to the right place! Bipolar disorder is a complex mental health condition that affects millions of people worldwide. We have previously written about the difference between bipolar and unipolar depression. In this blog post, we will delve into the intricacies of bipolar depression, drawing insights from a lecture by Dr. Shefali Miller, who was at that time a Clinical Assistant Professor of Psychiatry and Behavioral Sciences at Stanford University Medical Center.  Placing BP Depression along the Bipolar Spectrum When we think of bipolar disorder, many of us immediately picture dramatic mood swings – soaring highs followed by crushing lows. However, the reality is far more nuanced. Dr. Miller explains that bipolar disorder is characterized by fluctuating periods of depression and mood elevation, with the latter manifesting as either mania or hypomania. It’s crucial to understand holistically that bipolar disorder is not just a matter of emotional instability. It’s a serious mental health condition that can have profound impacts on a person’s life. In fact, individuals with bipolar disorder face a suicide risk that’s 20 to 30 times higher than the general population. This sobering statistic underscores the importance of proper diagnosis and treatment. The Challenges of Diagnosis One of the most significant challenges in treating bipolar disorder lies in its diagnosis. Dr. Miller points out that 40% to 60% of patients with bipolar disorder are initially misdiagnosed with unipolar depression. This misdiagnosis can lead to delayed or inappropriate treatment, potentially exacerbating the condition. Why does this misdiagnosis occur so frequently? There are several reasons: Similarity of Symptoms: Depression looks remarkably similar whether it’s part of bipolar disorder or unipolar depression. Onset of Illness: About half of bipolar patients experience depression as their first mood episode, making it difficult to distinguish from unipolar depression initially. Lack of Awareness: Patients may not remember or recognize past manic or hypomanic episodes. However, there are certain risk factors that might indicate a higher likelihood of bipolar disorder: Early Onset: A first major depressive episode before age 25 doubles the likelihood of bipolar disorder. Family History: Having a first-degree relative with bipolar disorder increases the risk by 2.5 times. History of Psychosis: This triples the likelihood of bipolar disorder. The Genetic Component One intriguing aspect of bipolar disorder is its strong genetic component. Dr. Miller highlights that bipolar disorder is significantly more heritable than major depressive disorder. While having a first-degree relative with major depression increases your risk by about three times, having a first-degree relative with bipolar disorder increases your risk tenfold. This genetic link is even more pronounced in identical twins. If one twin has bipolar I disorder, the other twin has a 40% to 70% chance of also having the condition. This high concordance rate suggests that genetics play a crucial role in the development of bipolar disorder. The Burden of Bipolar Depression While mania and hypomania are often considered the hallmark symptoms of bipolar disorder, it’s actually depression that accounts for the majority of the illness burden. Dr. Miller presents data showing that patients with bipolar disorder spend a significant portion of their time in depressive states. For individuals with Bipolar I disorder, about a third of their time is spent in depression, while those with Bipolar II disorder spend nearly half their time in depressive states. This predominance of depression has significant implications for treatment and quality of life, but its prevalence helps us with a holistic understanding of bipolar depression better.  Impact on Functioning and Suicide Risk Understanding that bipolar depression can have a devastating impact on an individual’s life is an important step. It affects occupational functioning and overall quality of life, often more profoundly than manic or hypomanic episodes. Even milder, sub-threshold depressive symptoms can lead to significant functional impairment. Moreover, the risk of suicide attempts is significantly higher during depressive or mixed episodes compared to manic or hypomanic states. Individuals who experience more depressive episodes over time are at a higher risk of suicide attempts. The Ripple Effect: Impact on Caregivers It’s important to remember that bipolar disorder doesn’t just affect the individual diagnosed with the condition. It also has a significant impact on caregivers – family members and friends who provide support. Dr. Miller notes that bipolar depressive episodes are associated with a greater caregiver burden than manic or hypomanic episodes. This increased burden can lead to depression and health problems in caregivers themselves. It’s a stark reminder that support systems are crucial not just for patients, but for their caregivers as well. Treatment Approaches When it comes to treating bipolar depression, there’s no one-size-fits-all approach. Treatment strategies are typically tailored based on the phase of the illness the person is experiencing. This personalized approach is crucial given the complex and cyclical nature of bipolar disorder. While Dr. Miller’s lecture doesn’t go into specific treatment modalities, it’s generally understood that a combination of medication and psychotherapy is often most effective depending on the stage your doctor works with you: the broad stages being “acute” and “maintenance”. Mood stabilizers, antipsychotics, and antidepressants (used cautiously) may be prescribed, along with therapies like Cognitive Behavioral Therapy (CBT) or Interpersonal and Social Rhythm Therapy (IPSRT). She does name several medications, but we won’t mention them here because it is best to talk to your healthcare provider to have a nuanced conversation. At BP Harmony, we advocate for regularly cultivating Sleep, Nutrition, Movement, Mindfulness, and Community as a key part of recovering from the acute phases of bipolar disorder. The Importance of Support One aspect that Dr. Miller emphasizes is the importance of support, both for individuals with bipolar disorder and their caregivers. Support groups like those offered by the National Alliance on Mental Illness (NAMI) or the Depression and Bipolar Support Alliance (DBSA) can be invaluable resources. These groups provide a space for individuals to share experiences, learn coping strategies, and feel less isolated in their struggles. For caregivers, they offer much-needed

Bipolar Disorder & Anger: Understanding and Getting Control of Irritability Introduction Bipolar disorder presents itself for many as wild swings in emotions, and one of the most challenging aspects is managing anger and irritability. These intense feelings can wreak havoc on our relationships and careers if left unchecked. Let’s outline the many ways to tame our inner, emotional beast! Anger is a normal human emotion. But for those with bipolar disorder, it can feel like the anger dial gets cranked up rapidly to over 1000. During manic or hypomanic episodes, we might find ourselves snapping at loved ones over the tiniest things. And even during depression, that irritability can simmer just below the surface. The tricky part is that this anger isn’t just “in our heads.” When we get fired up, our bodies release stress hormones like adrenaline and cortisol. Over time, this can take a toll on our physical health, potentially leading to issues like heart disease and high blood pressure. Recognizing Your Anger Triggers One of the most powerful tools in our bipolar toolkit is self-awareness. Start paying attention to what sets you off. Is it lack of sleep? Poor food? Stress at work? Skipping your meds? Lack of exercise? Keep a mood journal and look for patterns. You might be surprised at what you discover! Some common warning signs that anger is building include: Feeling “on edge” or easily annoyed Feeling your heart race Clenching your fists or jaw Having racing thoughts Not being able to focus Feeling some level of chronic pain Feeling Fatigue Strategies to Cool Down the Rage Here are some tried-and-true techniques to help manage bipolar anger: Take a time-out: When you feel your temper rising, step away from the situation. Take some deep breaths, go for a short walk, count to ten, or find a quiet space to decompress. Get moving: Exercise is a fantastic way to burn off that angry energy. Go for a run, hit the gym, or move around rhythmically in your home. Practice mindfulness: Meditation and yoga can help you stay grounded and less reactive to triggers. Check out our resources on mindfulness. Communicate openly: Talk to your loved ones about your bipolar disorder and how it affects your moods. The more they understand, the better they can support you but also aspire to be merciful with them when they fall short in understanding. Create a family action plan: Work with your family to develop strategies for handling anger episodes. This might include agreed-upon cues for when you need space or when it’s time to seek professional help. Treat yourself to a nutrient-dense, hardy meal 3-4 hours before bedtime and hydrate sufficiently. The “I Am Worth It” Exercise Here is an exercise from Dr. Redford Williams’ LifeSkills program that goes by the mnemonic “I am worth it.”Ask yourself these four questions: I: Is this situation Important to me? A: Is my anger Appropriate given the facts? M: Can I Modify this situation? Worth It: Is taking action Worth It? If you answer “no” to any of these, it’s a sign to take a step back and cool down before proceeding. If it’s all “yes,” then you can address the issue calmly and constructively. Be Kind to Yourself & Others Remember, managing bipolar anger is part of the healing journey that can be overcome with practice and slow steps. There will be setbacks, and that’s okay. The important thing is to keep trying and to forgive yourself for past outbursts while also seeking the forgiveness of others we may hurt with our anger. With time and practice, you’ll get better at recognizing your triggers and keeping your cool. Living with bipolar disorder isn’t easy, but we’re all in this together. By understanding our anger, developing coping strategies, and maintaining open communication with our loved ones, we can lead happier, more stable lives. Stay strong bipolar warriors – you’ve got this!