Trish #26

Trish has suffered a major brain trauma. For a subarachnoid hemorrhage is like an atomic bomb that explodes in your brain. It is a long time after the explosion before one knows exactly what has and what has not survived the blast.

After struggling for nearly three weeks; eating through a feeding tube, breathing through a respirator and experiencing the paralysis of the left side of her body -- not to mention that one of those weeks was spent in a coma and the next week hardly awake -- it is no wonder that Trish has walked a very rough road toward her recovery. When people visit her for a few minutes, they are understandably amazed at her awareness and at her ability to engage. However, her family knows that all is not well. There are serious gaps in her knowledge and ability. She sometimes expresses rather skewed perceptions of reality. All in all, her progress is indeed remarkable and consistent. We have every reason to believe that she is on her way to full recovery. That doesn't mean that we don't get alarmed and a bit scared though. The blunt truth of the matter is, for the moment, she is not yet herself in some important ways. Her perceptions of herself and of the world and the judgment she forms from those perceptions, are unreliable. They are often accurate but sometimes they are not.

This morning, I was later than usual getting to the hospital. I had spoken at a funeral and so didn't arrive until lunch time. She was not in her room. So I went to the rehab dining room and found her there, staring at her plate.

"Are you hungry?" I asked.

'Yes," she replied.

"How long has your food been here?"

"About thirty or forty minutes," she guessed.

"Then why aren't you eating it? I asked.

"I don't know," she said.

Actually, her food had been there for about five or ten minutes. The reason she was not eating was because her brain is not doing an adequate job of instructing her body how to feed itself. To satisfy her hunger she must find a way to direct her hand to take the fork and move the food from her plate to her mouth. So, even though she wants to eat and is physically capable of feeding herself, she doesn't always make the connection between the ability to put her hands into motion and the need to do so in order to satisfy her hunger. She seems to wait for her hunger to get satisfied magically. She can't seem to remember what actions are required to make it happen.

"Darling, you have to move your fork to your mouth," I said. So she began eating. I had to remind her a few more times but soon she had fed herself all she wanted to eat.

All was well until she suddenly said, "I want my apple pie! Someone has taken my pie."

I looked around. Indeed, the other patients had apple pie. She did not.

"Honey," I said, " You can't eat apple pie. Your swallowing is not yet at a sufficient level."

Exasperated, she said, "I want to go to the next level. I want to be in the apple pie level!" But soon she was laughing and we went on to her room.

A few minutes later, she asked me to bring her a bottle of water.

"Trish, you can't have water." I answered. "You can only have thickened liquids."

"All human beings have a right to drink water," she insisted.

"Yes they do. But in your case you might get strangled. Its too risky. I just can't give you water until the doctors say that it is safe."

The day seemed to go on like that with Trish exploring reality, pushing the limits, trying to understand why the world seems suddenly "out of whack." As I got steadily worn out, I kept thinking about Bob Dimon.

Bob was the man for whom the funeral was held today. He was a man in our church who experienced the most remarkable miracle two years ago. He had been a violinist with the Phoenix Symphony before sinking into a mental illness over twenty years ago. So, for years, he sat in the back of our church staring at the floor, in a near catatonic state. He walked slowly about the church with his walker, seemingly unaware of much of the world around him. However, one night a couple of years ago, an African pastor who was visiting our church, suddenly shouted out at him from the platform. "Brother, I command you to throw away your walker and run," Isaac Ogbeta said.

I nearly fainted. I saw lawsuits and newspaper articles on their way. I was ready to step up and put an end to the foolishness when, to my surprise, Bob threw away his walker. He began to run around the church in a steady gait, smiling from ear to ear. Within a few weeks, his psychiatrist took him off nearly all his medication. After twenty years of darkness, Bob was restored to his right mind. He began playing his violin and conversing freely with everyone. He became a constant joy and delight to us.

The sad part of this story is that soon after this miracle, Bob found out that he had cancer. In his hospital room one day I remarked that it seemed cruel that God would heal his mind only to allow him to suffer an incurable illness. Bob kindly rebuked me.

"Not at all,"he said. I have been able to make things right with people I have wronged. I have enjoyed the sunrise again. I have been able to read my books. I play my violin. These two years have been a gift. I would not have wanted to die with a clouded head!"

Bob then pulled out the violin that he did not play for twenty years and played Mendelssohn's Elijah for me. Before I left his room, he put down the violin and said something that will stay with me forever. "Pastor, it is far better to live in reality no matter how painful than to live in fantasy, no matter how pleasant. For years I lived in a world that I created in my own head. That was the ultimate idolatry. Now I am living in the real world and the real world happens to contain cancer."

I have rarely heard such wisdom and grace.

When we insist on creating our own isolated perception; when we will not allow our perceptions to be challenged, we descend into mental illness. For mental health is the humility and the wherewithal to constantly check our perceptions against those of others. Every human being has the ability to create whatever world he or she wishes inside the privacy of his or her own head. But to the extent that we create an inner world that does not correspond to the world outside our heads, we lose our grip on sanity. Sanity, in other words, requires humility and accountability.

Trish loves me. She calmed down after I told her that in her present state, apple pie can seriously harm her. She even accepted my claim that the water she craves is not safe for her to drink. Though Trish is a very independent woman and is not usually prone to give up her own opinions so easily, she is able somehow to understand that her brain is not yet working as it should. So she is allowing me for the moment to keep her perceptions accountable. She is not likely to get into serious difficulty as long as she does this, as long as she keeps submitting her perceptions to a "reality check."

Once again, Trish's struggle reveals an important truth. We all get mad as hatters when we become unaccountable. If no one can challenge us, rebuke us, differ or disagree with us, we are well on our way to mental illness. I have lived long enough to see spiritually powerful people become just plain nuts because they come to believe that they were too spiritual to accept correction or challenge. I have worked in mental health with patients who had become so highly respected in their fields that they rose above all correction and accountability until no one could challenge their judgment. After a while of living this way, their sanity began to unravel. Unaccountable imagination and unchallenged cognition is like a river without banks; it soon becomes a swamp. This is true in the board room and the courthouse, in the ball field and on the battleground.

In his mercy, God will place us in situations that force us to reexamine our thoughts and actions. Sometimes, he will withhold from us things that we really believe are ours by right. Sometimes, no matter how much we plead, he will not advance us to the "apple pie level" because he knows we will choke on the sweetness. The question is, will we trust him? Will we accept God's invitation to live in reality even when it is painful rather than flee to fantasy because the world we can create for ourselves is so much more convenient and pleasant?

Trish will keep emerging from the shadows. Her mental life will steadily improve. I believe this because she has the humility and the grace to trust that I love her and that I will not willingly deceive her. She believes this so strongly that she is willing to turn away from a glass of water because she suspects that for the moment her own judgment and perception is not as trustworthy as mine. When she gets well, that level of trust in me (and that level of distrust of her own judgment) will be inappropriate. As she improves, she can (and should) question my judgment and mental clarity when it doesn't seem right to her. (and believe me, she will have no problem doing that!) For the moment though, she values the search for sanity more than the sweetness of getting her own way.

I honor Bob Dimond tonight. He now has a clearer mind than any of us here below. I have no doubt that as you read this e-mail, he is meeting with Jesus and Bach. I also honor my courageous wife. She is still in the middle of her greatest struggle. But she will win. For she is armed with the same grace and humility that Bob discovered two years ago: the belief that is worthwhile to work for one's sanity by turning away from self -serving illusion in order to accept community and appropriate care from others.

In the end, sanity is merely the ability and the willingness to live in a mental environment of mutual accountability. Outside that environment lurks madness.