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“Weep with those who weep.”
(Romans 12:15b)
Was it during my first visit as a candidate or did they wait until we had accepted the charge? Either way, one of the first pastoral duties I was encumbered with fresh out of seminary was a request to pray for one of the elders. He had suffered a devastating stroke more than a year previously. This left him with nearly complete paralysis of one arm and concomitant weakness in the leg on the same side. Floyd and his wife begged me to pray that he would be healed of his infirmity.
When I called and asked Mrs. Brown if she had been back to her physician for rescheduling of her total hip replacement she said, “No.” I wondered if that was because she had been found to have heart disease. To this she said, “Yes, and we no longer have any health insurance so I can’t afford to go back to the other doctor.” “That must be very difficult for you,” I said. She wept.
In my dual roles as pastor and disability examiner1 I have literally had dozens of these sorts of conversations and analyzed the claims and records of thousands more whose difficulties overwhelm their capacity to cope, forcing them to reach past their embarrassment to family, strangers, churches, even the government, for help. As Dr. Jeffrey Boyd2 notices, the problem is mostly modern, caused in large part by better nutrition, better education, better access to treatment, and the “miracle of modern medicine.” People live longer. What used to be catastrophic illness now can often be treated. Often symptoms can be dampened or the negative effects softened, but not completely eliminated. The result is that society has a growing segment of people living with chronic illnesses, disability, and pain. These folks are often desperate like the woman who spent all her living on doctors and grasped at the hem of Jesus’ garment in frustration to find relief from chronic bleeding (Luke 8:42bff). Not long ago I adjudicated a claim for a now 18 year old boy with multiple impairments. He could see but only on the periphery of his vision. Apparently he understood a few words, but was mostly non-verbal. Feeding was through a “g-tube.” This youngster was wheelchair dependent and completely unable to manage his own hygiene. Somehow his mother has managed to find the care he has needed over the years—but only with great personal sacrifices and great personal stress. Not only was the child disabled, the family was enmeshed, bound by his needs and problems.
Perhaps it is helpful to notice that there are different causes for disability, with no clear-cut correlation between etiology and functional impact. What this means is that not every quadriplegic will be emotionally debilitated even though she is wheel chair bound. On the other hand, the fact that one sister from the same abusive family background thrives, does not call into question the seriousness of her sibling’s post-traumatic stress disorder (PTSD)—which keeps her from venturing into public to seek a job by injecting recurrent nightmares into her daily activities.
Several categories can be discerned. Physical deformities and injuries often lead to disability. Congenital anomalies are obvious—a person born with a clubbed foot, or an absent hand, or with developmental abnormalities such as spina bifida, cerebral palsy, etc. Car accidents, sports injuries, or being the recipient of violence cause physical injuries no less serious, no less limiting. With some of these, even finding the source of pain can be daunting—“complex regional pain syndrome” is the name now given to pain syndromes restricted to one extremity, for which a specific pathology cannot be isolated.
When I started my job as a disability examiner one of the senior adjudicators told me that there were three sources of disability which we control—smoking, drinking, overeating. I have seen countless claims where smoking resulted in horrendous pulmonary problems, drinking produced liver failure, and obesity was the cause of chronic joint pain, and linked to heart failure. Still, no one deserves to feel crummy, to be sick, to gasp for every breath—even if his or her own behavior damaged his system to the point of chronic illness. Aging and deconditioning lead to arthritis and soreness in muscles and joints when called upon to do what used to be easy. A vicious cycle ensues—it hurts so we do less; which makes it hurt more when we do a little, so we do even less. More pernicious are the illnesses beyond our direct management. Even the closest monitoring still doesn’t cure Type I Diabetes or preclude its ravaging of the body, nor can medicine do more than briefly delay the inexorable course of Lou Gehrig’s disease. But even here, patients can live for years—such as physicist Stephen Hawking.
Mental impairments are equally limiting. Christians have historically been at the forefront helping those with limited intelligence, autism, Down’s Syndrome or similar conditions. Where we are less skilled is dealing with the growing numbers of people consumed by guilt, anxiety, anger, depression, psychosis. Emotional dysregulation and psychosis can be helped by medication and therapy but by observation pastors and churches are inept in knowing how to respond appropriately to those whose “self-talk” leads them to cut, or blow up, or abuse others, or stay away from those who might be able to help. People whose behavior is weird are tough to embrace; even their responses to love are often unusual, so it’s easy to give up trying.
At least 60% of the Disability claims I handle at work have some component of mental impairment. Perception of limitation, whether reality based on not, has a huge impact on an individual’s ability to deal with stress, to cope. Chronic Fatigue Syndrome usually has a combination of mild anxiety and depressive symptoms with extremely easy fatigability. Medical findings are usually sparse. But these people often have no more ability to get up and go to work than the Viet Nam vet down the road disabled by a bomb blast 35 years ago. The medical findings in CFS cases suggest these folks should be able to work; the actual functioning belies this.
Social Security requires that examiners handle every disability claim on a “case by case” basis. This becomes a nauseating mantra but represents wise advice. The point is that broad generalizations must be set aside when it comes to dealing with people and the functional impact of their impairments. Symptoms matter—imagine trying to work with chronic fatigue, nausea, shortness of breath, dizziness, panic, voices saying “You’re stupid!” or “Kill Frank!,” etc. Or especially with pain—this is the great leveler, the “evil” nearly everyone seems to want to eliminate.
“Weep with those who weep.”
This is not trite. The first step in helping people with chronic illness and/or chronic disability is empathy, not “solving the problem.” By the time someone will come to one of us—a pastor or church worker, with concerns about their difficulty they almost always have already been to a range of outside experts. Begin by trying to understand how the impairment(s) impact on their daily activities, how it affects their functioning, and what they wish they could fix or change as a result.
Second, help them learn to manage symptoms. This involves a variety of helping possibilities secular and spiritual. First the secular: encourage “appropriate” medical care. Popular cures for arthritis can be helpful but should not be substituted for lab work and visits to a rheumatologist—perhaps the church can help with the cost of this if need be. Recommend that community services be used when available—social welfare, community action, Catholic charities, State Agency on Aging, etc. The Visiting Nurse Association has been nothing short of a godsend to one of my elderly friends. Investigate family connections. Getting the family of someone with a disability involved is usually helpful, though not always. Still, it’s usually worth helping the “natural” network recognize that one of its own needs assistance. Sometimes all that is needed is a different perspective. One lady sadly told me that she was having a terrible time sleeping at night since her husband had died. The bed seemed so empty without him. I suggested that she might benefit from not sleeping in her double bed. So she got a “twin” sized bed and the problem resolved.
Spiritually there are resources we can and should offer. The first is prayer and/or anointing with oil. We should petition God for help, comfort, strength, resources and, yes, healing. But we should not create false hope. We are to cast all our cares and anxieties upon him, knowing that he cares for us (1 Peter 5:7) but we must also recognize that God’s assessment of the situation and what works to accomplish his plan and redound to his glory may not include resolution of difficulty in the ways we or those for whom we intercede envision. To Moses God said, “Who makes him (man) mute, or deaf, of seeing, or blind? Is it not I, the Lord?” (Exodus 4:11 ESV). St. Paul had to learn that his“thorn in the flesh” was not going to be removed even though it was a “messenger of Satan” (2 Cor 12.7). For him, and often for us and our parishioners God intends that “his grace,” his favor apart from healing, is sufficient. In weakness, his power is better displayed. Disability, pain and suffering have often been God’s trumpets calling us to obedience and deeper trust. In the face of her third bout with cancer one of our friends pointed to Psalm 94:17-19 as a great help: “If the Lord had not been my help, my soul would soon have lived in the land of silence. When I thought, ‘My foot slips,’ your steadfast love, O Lord held me up. When the cares of my heart are many, your consolations cheer my soul” (ESV).
Many of the emotional disorders which plague people have symptoms which require spiritual action. A few years ago I had a claim of a woman who was nearly paralyzed by anxiety and panic attacks. It turned out that much of this was related to her extreme worry that someone would find out she had embezzled a large sum of money from her previous employer. A wise pastor encourages confession and restitution. Similarly, those whose past has been filled with abuse, belittling and torment may need gently to be encouraged to forgive the perpetrator(s). Hatred and vengeance tend to do as much damage internally as they do to the outward object. As Jesus indicates, until we are able to offer forgiveness we won’t be able to experience it personally (Mt 6:14,15). Complicating many of the emotional disorders is alcohol and/or drug abuse. Sometimes dependence on pain medications creates as many problems as it attempts to resolve. Pastors should be aware of the impact these substances have on a man or woman’s ability to resist temptation, handle stress and function appropriately.
One area where the church is particularly well equipped to help is by friendship and visiting. Those who are shut in by reason of disabilities are typically lonely. It often does more good than medicine when church friends, beyond just the pastor, visit, take turns doing chores, help someone with shopping, mow the lawn, etc. The body of Christ can and should minister to its own when there is need, in this sort of practical way. In this vein, it is a great relief to a stressed out parent to be able with a call to secure someone to stay overnight with the rest of the family when there’s a situation that necessitates an unexpected ER visit.
Finally, a word of caution for those of us trying to help. Once in a while we need to take a break, seek respite entirely away from the line of service. I have a colleague who worked for a while in juvenile justice. Mostly she was dealing with sexually aggressive adolescent boys. After a while she said she had to quit the job. Why? “Because it began to seem normal.” That’s true for those who offer care to those chronically ill. The illness can begin to seem “normal.” It’s easy then not to feel compassion, or to develop a sense of victimization. Getting away brings refreshment, renewed perspective, opportunity for reassessment.
Nearly every coach I’ve known has the same mantra, “When the going gets tough, the tough get going.” The point is that there will be times when it’s hard to proceed, it hurts, it’s a struggle. Courage is necessary. Pastors need to take a measure of this and offer it to our charges. Life is messy, difficult and hard. Along with the grace of God, a healthy dash of courage is almost always required when facing chronic illness, disability and pain.
1 For 13 years I have worked at the VT Disability Determination Services as an adjudicator for Social Security Disability Insurance Benefits. At the same time I have been engaged in pastoral ministries.
2Jeffrey Boyd, “A Biblical Theology of Chronic Illness,” Trinity Journal, Fall 2003, pp. 189-206