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Friday, July 31 2009
 Over the past couple of weeks I have been having fun acquainting myself with Twitter and Facebook. Facebook has been around for awhile but I have not paid much attention to it other than to try to keep up with one of my daughters prodically. On the other hand although Twitter has been out for a couple three or four years I had little to no knowledge of it. So it was with fear and trepidation I ventured into the world of social networking especially trying to look at and understand Twitter and what all the hoopla was about. 

Now for some time I have been developing a website for the sole purpose of helping my patient/clients with timely information available to them on the web and with questionnaires that would enhance and expedite our counseling experience together; however, finding relevant information in the world of cyberspace had not been my forte'. Initially I was overwhelmed with the technology and how much information was out there and available to any one who wanted to find it. And then I became gradually aware that much of the information was repetitive and being reproduced over and over again in different formats and different forums. Gradually I'm becoming familiar with the medium and have reached a few tentative conclusions. 

Yes, there is a lot of information. Much of the information is being reproduced and re-packaged each day in different formats by different people. There are probably 10-15 relevant studies or pieces of information for me and my practice being produced around the world on any given day. Finding this information is becoming increasingly easier with the help of all the fellow social networkers many of whom have access to sources that would not normally be available to me unless I paid or subscribed to several journals or newsletters and then would not be as immediately available due to publishing and delivery times.

However, there is a lot of information that is more opinion than knowledge and once repeated over and over begins to take the form of gospel even if it is not. In addition, the amount of real wisdom or knowledge from experience is even less present. This is not a criticism just a recognition of the value of social networking and the realization of its limitations. Keeping it in perspective Twitter, Facebook and the other social sites are invaluable. The social exchange on the web is enlightening and engaging. The amount of real world knowledge is there but limited and the amount of wisdom is even less so. However, keeping everything in perspective the social networking is a great deal of fun and a real hoot!

Helping Hearts Heal, 
Dr. Dan L. Boen

Posted by: Dr. Dan L. Boen AT 03:25 pm   |  Permalink   |  Email
Tuesday, July 28 2009

Leadership Journal

Survival Skills
What you need to minister with your spirit intact.
James Emery White

Monday, July 27, 2009

I was having coffee with a fellow pastor who needed more than caffeine to pick himself up. Summer attendance was down. Key people were leaving because of disagreements about the direction of the church. And money was very, very tight.

I felt nothing but empathy. Yep, been there, felt that.

"Jim," he said, "I knew seasons like this would come. I just didn't know how stressful they would be."

I agreed. To this day, the disappointments can still blindside me. Nothing prepares you for how ministry can drain you emotionally, leaving you in pain or, even worse, feeling numb or in despair or seething with anger. This is why so many good men and women in ministry have careened into moral ditches or still soldier on with plastic smiles and burned out souls.

A few years ago, my wife Susan and I were part of a mentoring retreat with about a dozen couples. We started off with an open-ended question: "What are your key issues right now?"

As we went around the room, the recurring answer was "emotional survival." We heard about the hits and hurts that come our way as occupational hazards. And how they tear away at our souls, sapping our enthusiasm, our creativity, our missional stamina. They leave us creating dreams of finding ourselves on a beach with a parasol in our drink—permanently.

How can we develop the survival skills to withstand the hits and hurts? It starts by recognizing the most frequent causes of spirit-drain.

Overbuilt expectations

When you enter ministry, you can't help but dream. For many of us, we dream big. That's one of the marks of a leader—a compelling vision for the future. But for almost everyone, it's not long before the dream collides with reality.

When I planted Mecklenburg Community Church in 1992, I just knew (though I wouldn't have said so) that we would be a church in the hundreds, if not approaching a thousand, in a matter of weeks. Willow Creek, eat our dust.

The reality was starting in a rainstorm with 112 people, and by the third Sunday, through the strength of my preaching, looking out at 56 folks. Actually, 15 or 20 of those were kids in another room, so maybe 40 were actually in worship.

Yes, our numbers did eventually increase, but I don't care what kind of growth you have—you usually had hoped for more. And that can be draining.

It is easy to substitute doing ministry with true communion with god.

It's even worse when you play that dark, insidious game called comparison. When you compare yourself to other churches, inevitably you look to those that are bigger or newer or more prominent in some way. You measure yourself against them, whether in size or style or impact or atmosphere. And that sets you up for a letdown. We say, "It's all kingdom work," but too often, the comparisons drain us of energy and motivation.

And then there are the day-in, day-out realities of serving in a church that is very real, very flawed, and very challenging. No matter how well it goes, you have problems, issues, hassles, defections, setbacks, barriers, and defeats. You have to live with a level of quality about ten miles below what ignited your dream. It's work—hard work—and you realize that it could take years for even a glimpse of your dream to become reality.

And those are just your expectations. Then there are the hits that come from the expectations of others.

Unsafe people

Henry Cloud and John Townsend wrote a book titled Safe People, but it was really about "unsafe" people. Church leaders attract such folk as an occupational hazard. They enter our lives and may make a big first impression with their giftedness and enthusiasm. They often talk about the sorry excuse for a church they used to be involved in, and the dark side of your spirit enjoys hearing about it just enough to ignore the warning their words hold.

As a church planter, I was so desperate for encouragement and help that I ignored the red flags time after time. They're willing, eager, and have experience in ministry, so you fast-track them into leadership. You give of yourself relationally, even lean on them emotionally, opening your heart to them about your struggles and fears and weaknesses—and then it happens.

The person you thought was a God-send turns out to be your worst nightmare. Your number-one fan becomes your number-one foe.

You'll understand if I change a few tell-tale facts in the stories for this article.

Shortly after we started Mecklenburg, a man arrived who had a strong, outgoing personality and eagerly championed the vision of the church. He'd been involved with a similar, and well-known, church.

He was willing to serve, had previous experience, understood the vision. He even tithed! What wasn't to like?

But as the church grew and other leaders took responsibility, decisions were made and teams were formed without his involvement. Instead of welcoming the vitality, he became threatened and turned hostile, particularly toward me.

I vividly recall the day things exploded. We had just moved into our very first office, a small suite with two rooms and a work area. This man had gone in and arranged the furniture as he thought it ought to be. I assumed he was just being nice, but as it turned out, that was his way of marking his territory as the church moved into a new era.

Other leaders came to me and said, "What do we do? We appreciate his efforts, and we don't want to hurt his feelings, but we want to arrange our furniture our own way."

In a blazing moment of naivete, I said, "I'm sure he won't mind. Go ahead!" Two days later, we made one of the first major purchases as a church—a copier. And we rearranged the office when it was installed.

When this man saw that we had reorganized the office and made a "major purchase" without his knowledge, he was not happy. His attitude took a major turn, and I didn't have the ministerial street smarts to see it coming. Complicating things further, over the next few weeks we put together a management team that did not include him. Game over. He went on the warpath.

Where I was once the one he was eager to support, I now could do nothing to please him. He began talking to anyone who would listen, spreading all kinds of innuendo. I tried to talk with him and reconcile, but he wasn't appeased. He was mad and wanted others to know he was upset.

And because he was a high-profile person, and we a small church, it ripped the guts out of the place. And out of me!

The turmoil went on for three months. Finally, when he realized he wasn't succeeding in getting other people to revolt, he left, but only after writing a scathing letter to everyone on the management team, accusing me of being loose with the church's money (the copier), and of being autocratic (establishing the management team).

I tried to talk with him in person, but he refused. So I wrote him a letter explaining my decisions. All that did was generate another round of angry letters sent to other people. So I just let it go and tried to move on. But you don't just move on from those things. The harmony of the church (a fragile new church) was damaged. It also emotionally wrecked me and my church planter's idealism.

About that time, I talked to a pastor in another state. He told me about his new church, and in his efforts to solidify the structure, a man who had been part of the founding core was not invited to be part of the new leadership team. The man went on the warpath and sent letters to everyone in the church accusing the pastor of financial wrongdoing, of being autocratic and dictatorial. When I heard that, I thought, What? Is there a school where they train people to do these things?

Nothing hurts more than someone you thought was a friend turning against you and attacking you personally. Little did I know that in ministry, I could look forward to many more encounters with "unsafe people," some who, through their actions, would be able to throw the entire church into crisis mode.

Crushing Crises

It was Friday night, we were getting ready to leave on vacation the next morning, and the phone rang. It was one of our staff. For him to call me at home on a Friday, much less the night before I was leaving for vacation, was not a good sign.

"Jim," he said, "I have a room full of people here at my house. There's a crisis. They thought you had already left, so they came to me."

"What is it?" was all I could manage to say.

He gave me the name of another staff member, and said, "Jim, they're here because they've discovered she's been having an affair." And then he named the man she was involved with, who happened to be on our worship team. Let's just call them Jane and Bob.

I collapsed on the side of the bed as I held the phone in my hands. Thus began one of the worst experiences of my life and of the life of our church. After a night of no sleep, the next morning, I met first with Jane. Then I met with Bob.

So much for vacation.

It was all true and had been going on for several weeks. She ended up resigning, and Bob and his wife left the church. It rocked our church's world. And mine. The ripple effects were incredible.

From a purely organizational level, it tore the guts out of our then fledgling music ministry. She was the leader of our band, our main musician, and our lead female vocalist. Her husband was our tech person. Bob was our lead male vocalist, and his wife our only keyboardist. Our band no longer existed. Suddenly we found ourselves using "tracks" for our weekend services.

But that was nothing compared to the emotional hit.

There was the pain of the two families with a husband and a wife who felt utterly betrayed. Then there is the pain you feel as a pastor—you feel violated, sick to your soul. You feel sick as a leader—this church that you love so much, that you'd lay down your life for, suddenly ripped apart. And you are supposed to sew things back together.

In these situations, no matter how you handle the folks involved, you'll have some people who think you went too far on the side of grace, and others who think you went too far on the side of discipline.

We got through it as best we could, and with as much truth and grace toward both parties as possible, but Bob and his wife left very upset with us. They felt Bob should have been allowed to return to the platform after just a couple of months of counseling, and they accused us of showing partiality to Jane because she was on staff.

So in the end, after we had poured ourselves into them for their reinstatement, loved them as best we knew how, they rejected us and left angry, taking with them four or five families who were their close friends. It was one of many crises.

Necessary Survival Skills

There are so many other emotional hits. The stress of finances—both personally and in the church—the departure of staff, the pain of letters that criticize your ministry, the pressure of people who want to redefine the vision, mission, or orientation of the church, the agony of making mistakes. And then there's this little thing called your marriage and family.

In ministry so many things can sap your emotions and strength, your very soul and spirit, almost daily.

So what can you do?

There's not a quick fix. Instead, my emotional survival has depended upon a way of life that protects, strengthens, and replenishes me emotionally. This means I've had to cultivate a set of activities and choices that allow God to "restore my soul."

Your list may be different, but here is mine:

1. A regular day off. I take a day off every week, and I'm really off. It's the last part that matters. It's so easy to let ministry tasks, emails, phone calls, text messages, and work demands weave themselves into every nook and cranny of every day. It takes self-discipline and clear intent to actually have a day off. For me, it's Friday, so that I can unwind before our weekend service schedule begins.

Once a month, I also go on a spiritual retreat in the mountains. I drive away from the office on a Thursday afternoon, stay overnight at a little bed and breakfast, and come back the next afternoon. The time is spent in a place that is renewing, a manner that is renewing, and with a God who is renewing.

2. An annual study break. I take an annual study break of four to six weeks, where I physically relocate. This isn't vacation, but a time of intentional spiritual and emotional renewal for the tasks at hand. Those who teach and lead have to pour out instruction and guidance to others, and need to have annual times not just to rest, but to replenish themselves. This is a time to separate myself from the emotional wear and tear but still invest myself in issues related to ministry.

When I'm on study break, I read widely, travel broadly, visit other churches intentionally, map out another year of teaching strategically, and tackle large leadership challenges diligently. I've taken a summer study break of some kind for nearly 20 years, and it's one of the reasons why I'm still thriving in ministry today. Like an athlete that goes through a grueling season, you have to stop, give your emotions time to heal, all in order to enter a new season.

3. Clear boundaries regarding giftedness. As a pastor, you teach people about spiritual gtifts, and the importance of making that gift their area of primary investment. I've had to learn to apply this teaching to myself. There will always be times where you have to serve as needed, but staying primarily within your gift mix is preventative medicine against burn-out, because nothing will drain you faster than operating outside of your giftedness.

I do not rank very high with the spiritual gift of mercy, not to mention how that plays itself out in, say, extended pastoral counseling. If I had to invest in that area with ongoing, regular blocks of time, it would wipe me out. I've had to learn to be very up front with folks about my areas of giftedness, and how those gifts are supposed to operate in the mix with other people's gifts in the body. Because what happens in a church, even one where spiritual gifts are taught and celebrated, is that the pastor is still expected to have them all—and to operate in them all. The danger is that you'll let yourself try.

4. Emotionally replenishing experiences. I've had to learn to intentionally pursue emotionally replenishing experiences. When you hurt, if you don't find something God-honoring to fill your tanks with, you'll find something that isn't God-honoring. Or at the very least, you'll be vulnerable to something that isn't. I am convinced this is why so many pastors struggle with pornography—it offers a quick temporary emotional lift.

To prevent that, I've had to learn to do things that flow deep emotional joy into my life. For some folks it's boating, or golf, or gardening. For me, it's travel, pleasure reading, time alone with family, and enjoying anything outdoors—particularly the mountains.

5. Real time with God. The most strategic investment is time with God. But not just any time with God—I must have time with God that touches me at a heart and soul level. Every day, I seek to spend some time pouring out my heart, and in turn, receiving his. Few people had the emotional ups and downs of David, and if you read the Psalms carefully, you see that he poured out his emotions to God in a disarmingly candid way. Learning to pray like David has been healthy for me.

Soul Strength

Ministry can be hazardous to your soul. Since we're always doing spiritual things, it is easy to substitute doing ministry with true communion with God. Plus, so many people assume we're spiritual, it is tempting to believe that and let the estimation of others be the standard by which we judge the state of our souls. From this, there can be enormous levels of self-deception in regard to our spirituality. Coupled with the emotional drain of our vocational lives, we are terribly vulnerable.

I had a defining moment years ago when a mentor in the faith fell into moral failure. I thought, If that can happen to him, it can happen to me. It terrified me. At the time I was in a season where I was emotionally drained and spiritually undisciplined. I was overwhelmed with my own vulnerability, and with the realization that no one would ever own my emotions, much less my spiritual life, but me. If I was going to endure in ministry, it would have to be my responsibility. I knew that a personal resolve was called for.

And I made it. You've just read a list of some of the life-changes birthed as a result.

There are so many other investments I have learned to make or seen others make, such as the importance of healthy staff community, safe friends, and effective Christian counseling. They all matter, because the best gift I can give the Kingdom of God as a ministry leader is a healthy, whole, sane me. The hits and hurts of expectations, unsafe people, and crises will never end. But I can be in better shape for them when they do come, and give God my best to still be standing after they are over.

James Emery White is pastor of Mecklenburg Community Church in Charlotte, North Carolina.

Posted by: Reviewed by Dr. Dan L. Boen AT 04:43 pm   |  Permalink   |  Email
Sunday, July 26 2009

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You Are Who You Are by Default

- July 25, 2009

Originally Published:20090718.

You may not be riding the latest social wave on Facebook or MySpace, or tweeting your every impulse to fans on Twitter. But your brain is hooked on networking.

Vision works because different brain regions link up to connect the dots of light and color into a meaningful picture of the world. Language depends on networks of neural circuitry that make sense of the words you hear or see and that help you generate your side of the conversation. Networks of nerves control the motion of your muscles, allowing you to move smoothly and, when necessary, swiftly.

Networks are the "in" thing for brain scientists, as surely as they have been for online social butterflies.

Scientists learn about the brain's networks by asking people to perform all sorts of mental acrobatics-interpreting optical illusions, solving riddles, taking tests of mental or muscular skills. But some neuroscientists think they can learn even more about the brain by asking volunteers to just lie back, close their eyes and let their minds wander.

Such unstructured journeys of the mind-be they planning tonight's dinner, thinking about that meeting at work and what your boss said afterward, debating whether to drive or fly for your next vacation, or recalling that day in your childhood when you first sat in your new tree house listening to birds chirp-turn out to offer clues about one of the most important, mysterious and well-connected networks of all. It's called the default mode network, and it's responsible for what the brain does when it is doing nothing in particular. It's the brain's core, both physically and mentally, and it's better connected to the brain's system of circuits than Kevin Bacon is to movie stars.

"I think the default mode network is the most exciting thing that has happened in cognitive neuroscience in quite some time," says Peter Fransson, a neuroscientist at the Karolinska Institute in Stockholm.

Default brain settings may lead to daydreaming and mind-wandering, but the network also conducts serious business. Neuroscientists still hotly debate the network's exact functions, however. Among its jobs may be running life simulations, providing a sense of self and maintaining crucial connections between brain cells. A few researchers doubt the network is anything special at all.

But evidence suggests that a malfunctioning default network is involved in diseases and disorders as diverse as Alzheimer's disease, autism, depression, post-traumatic stress disorder, Tourette syndrome, amyotrophic lateral sclerosis, schizophrenia and attention-deficit/ hyperactivity disorder.

Busy behind the scenes

Despite its laid-back name, which neuroscientist Marcus Raichle coined in a 2001 paper, the default mode network is one of the hardest-working systems in the brain. It was discovered accidentally by researchers watching the activity of brains at work on various tasks.

Neuroscientists use PET (short for positron emission tomography) and functional MRI scanners to image and gauge brain activity. To tell which areas of the brain become more active during a mental task, scientists compare brain activity during the task with activity when the person is at rest, either with eyes closed or while staring at a dot or cross. Raichle, of Washington University in St. Louis, and others saw that every time a person engaged in a mental activity such as memorizing a list of words, a collection of brain regions consistently decreased activity compared with their resting levels. Only when people recall autobiographical memories or imagine alternative situations is the network more active than it is at rest, scientists have since found. (In this context, "rest" refers to a state in which the brain is not engaged in a mental task but is still monitoring the body and the world around it.) Raichle hypothesized that the network is more active when the brain is at rest and has to dial back its activity to let people concentrate on specific tasks.

Michael Greicius, a neurologist and neuroscientist at the Stanford School of Medicine, put the resting part of Raichle's theory to the test. Greicius and his colleagues measured brain activity while volunteers had their eyes closed and thought of nothing in particular. The team used a technique called functional connectivity MRI to reveal correlations in activity in different brain areas. The group reported in 2003 that blood flow in parts of the brain implicated in the default network rises and falls like the tides-in slow but synchronized waves.

Those coordinated parts of the brain-with cumbersome names such as the medial prefrontal cortex, posterior cingulate cortex, retrosplenial cortex, precuneus, inferior parietal lobe and hippocampus-are located mostly along the crevice separating the brain's hemispheres, and on each lobe behind and above the ears. Researchers don't agree on all the components of the default network, but consensus is growing that it has two major hubs: the posterior cingulate cortex, or PCC, with the precuneus, and the medial prefrontal cortex.

Functions ascribed to those two areas may give clues to what the default network is good for. The medial prefrontal cortex is involved in imagining, thinking about yourself and "theory of mind," which encompasses the ability to figure out what others think, feel or believe and to recognize that other people have different thoughts, feelings and beliefs from you. The precuneus and PCC are involved in pulling personal memories from the brain's archives, visualizing yourself doing various activities and describing yourself.

Together, these hubs give you a sense of who you are. Their prominence in the network has led some researchers to propose that the function of the default mode is to allow you to internally explore the world and your place in it, so you can plot future actions, including contingency plans for various scenarios you might encounter.

The network that never sleeps

Some scientists quibble with the name, but Fransson says the network really is the brain's default. Peter Williamson, a psychiatrist at the University of Western Ontario in London, Canada, agrees.

"You don't even have to be conscious for it to be apparent," he says.

Slow yet coordinated fluctuations in activity bind the network together. The syncopations continue even while people are asleep, under anesthesia or in comas. But it is unlikely that such activity reflects ongoing conscious processing, Greicius contends. The fluctuations that move through the network are incredibly slow, he says, with one cycle every 15 to 20 seconds. Most conscious thought happens in split seconds, so it is more likely that the plodding pulses are for "subconscious synapse maintenance," he says.

Synapses are the connections between neurons where cell-to-cell communication takes place. When two neurons stop "talking" to each other, connections between them can be severed. Greicius thinks the low-level fluctuations in the network help keep the neurons in contact, sort of the brain-cell equivalent of Facebook status updates.

While it is good to stay connected, reverting to default isn't always helpful. The default mode network sometimes stirs during monotonous tasks, drawing away a person's attention. Such reactivation of the network predicted errors up to 30 seconds before a person made a mistake, Vince Calhoun of the MIND Research Network in Albuquerque and colleagues reported in 2008 in the Proceedings of the National Academy of Sciences. And a study published May 26 in that journal, by Kaiina Christoff of the University of British Columbia in Vancouver, Canada, and colleagues, shows that not only is the default network involved in mind-wandering, it also distracts executive areas of the brain, so that people aren't even aware that their minds have wandered off task.

Psychiatric connections

Researchers are also studying how defects in the coordination between different parts of the default network may contribute to psychiatric disorders. Calhoun, an electrical engineer at the University of New Mexico, and colleagues at other institutions studied network activity during a memory task in 115 people with schizophrenia and 130 healthy people. Some subnetworks within the default mode network had trouble disengaging in people with schizophrenia, impairing their ability to focus on the task, the team reported online May 11 in Human Brain Mapping.

People with schizophrenia also have faster cycles of activity in their default networks during a resting state than healthy people do, Calhoun and another group of colleagues reported in the March 2007 American Journal of Psychiatry.

Williamson and colleagues, meanwhile, have shown that the default network's connections with other parts of the brain may be important in determining who develops PTSD after a traumatic event. People who have been traumatized can become numb and lose their sense of self, Williamson says. The researchers examined default networks in women who developed PTSD after trauma in childhood. The study found altered levels of connectivity among parts of the default network as well as between the network and other parts of the brain. The findings, published in May in the Journal of Psychiatry & Neuroscience, could indicate that trauma creates disturbances in the network's ability to create a sense of self.

The default network may also be the launching point for Alzheimer's disease's assault on the brain. The characteristic plaques of the disease deposit preferentially in the brain regions most associated with the network, studies have shown. And Greicius and his colleagues reported online last year in the June 2008 PLoS Computational Biology that activity in the default network is affected by the disease.

At least one study suggests that the default network may be vulnerable to Alzheimer's disease decades before symptoms or plaques show up. Young people who carry a genetic risk factor for the disease have more activity in the default network, particularly in the hippocampus, than young people who don't have the genetic risk, researchers from Oxford University and Imperial College in England reported in the April 28 Proceedings of the National Academy of Sciences. The authors say the study provides evidence for the theory that the default network's constantly high activity eventually burns it out, leaving it vulnerable to Alzheimer's disease.

Greicius says he isn't a fan of this "use it and lose it" theory. Other networks in the brain also burn a lot of energy, even at rest, but they don't fall prey to Alzheimer's disease. Instead, Alzheimer's and four other neurodegenerative diseases each target a different brain network, Greicius and colleagues including William Seeley of the University of California, San Francisco discovered. The results, published April 16 in Neuron, could mean that neurons that fire together die together. The researchers don't yet understand why. It could be that when a neuron dies, its silence triggers death in neighboring neurons, or neuron-killing substances might pass from one cell to another through synapses, Greicius says.

Blueprint for the brain

To understand what goes wrong with the default network to lead to psychiatric disorders, scientists need to understand how the network is built. Assembling disparate regions of the brain into a coordinated, coherent system surely is no simple task for the developing brain.

"One might imagine that the development of self might take a bit of time to sculpt," Raichle says.

Only a few studies have been done with children, so the picture of the nascent default network is about as clear as an ultrasound image is to someone other than an expectant parent. But new ways of analyzing neural connections are bringing the picture into better focus.

Fransson and his colleagues used fMRI to scan the brains of sleeping premature infants who had reached the equivalent of 40 weeks of gestation to see whether the default network is already in place when babies are first born. The researchers could not find evidence that the default mode is operational in newborns, although five other brain networks are already online, the team reported in 2007. Fransson says he is not surprised that newborns lack a network that draws on personal experience and dreams of what is to come.

"Infants cannot plan for their futures," he says. "They don't think about their pasts."

But a recent study by Weili Lin, a neuroscientist at the University of North Carolina at Chapel Hill, and colleagues shows that infants as young as 2 weeks have rudimentary, incomplete default mode networks. The study, published in the April 21 Proceedings of the National Academy of Sciences, tracks development of the network from shortly after birth into toddlerhood. Newborns' default networks connect six brain regions, Lin's group found.

It doesn't take long for the brain to develop a default mode, Lin showed. By age 1, babies link 13 brain regions in their default network, including 10 parts found in the adult network. In 2-year-olds, the default network is even bigger, comprising 19 regions, 13 consistent with the network in adults. But bigger networks can also be inefficient, Lin says, noting that adult default networks have been pruned of extraneous connections.

Lin and his colleagues are continuing to scan many of the children in the study as they age to track how the normal brain develops. Preliminary data from 4-yearolds indicate that extra connections are severed as the brain ages, he says.

A group of researchers at Washington University including Raichle, Steven Petersen, Bradley Schlaggar and Damien Fair (now at the Oregon Health & Science University) are piecing together the network's development from age 7 into early adulthood.

Brain connections in 7-year-olds are organized differently than in adults. Children have more short-range connections among neighboring brain regions and fewer long-range connections, particularly among the parts of the default network in the back and front, the team reported last year in the Proceedings of the National Academy of Sciences. As children age, the connections are rewired. Adolescents have a network structure somewhere between that of elementary-age children and adults.

"It's like different cliques of friends in childhood break up and create different cliques in adulthood," Petersen says.

Given the lack of long-range connections in children's brains, researchers were surprised to discover that kids' default networks aren't clunky. The team mapped how the brain makes connections in the network, a neuroscience version of the game to link actor Kevin Bacon to other actors in Hollywood through people with film appearances in common. Fewer steps means more efficient connections. While children's connections are structured differently, they have enough shortcuts to make information transfer in the network just as efficient as in adults, the scientists reported online May 1 in PLoS Computational Biology.

Once people reach adulthood, activity in the network is fairly consistent from person to person, with some slight differences between the sexes and in older versus younger people, Williamson and his colleagues wrote in a 2008 paper in NeuroReport.

This consistency in the network from person to person is remarkable, especially considering what its function is supposed to be. Everyone's brain is thinking different thoughts while in the default mode, Fair says, and yet all healthy brains in default mode look essentially alike.

Such fundamental issues are among the puzzles of the default network remaining to be solved.

"Nobody has really figured out what it is and what it does," Williamson says. "But somebody will."

(C) 2009 Science News. via ProQuest Information and Learning Company; All Rights Reserved

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Posted by: Reviewed by Dr. Dan L. Boen AT 09:02 am   |  Permalink   |  Email
Sunday, July 26 2009

Raising a Family 'Of Different Minds'

Katherine Britton News & Culture Editor

Identifying your child with learning differences rocks a parent’s world. What exactly do these “differences” mean? What does this mean for our family as a whole? How do I help my child succeed in a school that doesn’t cater to him? How do we help him help himself as he gets older?Amid these challenges, family life can begin to center around the “problem” child at the expense of other children, or even the spouse.

As "Of Different Minds" author Maren Angelotti found, her son without learning differences started to resent the attention given to his siblings with auditory processing disorder, ADD and dyslexia. Meanwhile, three other children with learning differences demanded multiple lifestyle changes for the whole family. Maren recently talked with about the challenges – and the joys – of integrating what she learned for her whole family.

Crosswalk: I think your book is different in a lot of ways because you focus very much on the whole, integrated family, while a lot of books focus just on the educational aspects for the specific child. Can you tell our readers a little bit about your own journey into the world of raising kids with learning differences?

Maren: It started as a young mom, noticing things that just weren’t clicking with my kids. And it wasn’t drastic. They were just little innuendos. They started in the toddler years—we used to laugh about it because the kids would take words and just twist them a little bit, and the meanings became so different. An example would be [when] we used to live in California and we’d drive by the ocean and my oldest daughter would say, “Hey, Mommy, look at the lotion.” And we used to go, “Oh, isn’t that so cute.” Just different things like that that we would kind of laugh about in the family. But I noticed as time went on, that auditorially they weren’t processing the words correctly. And so, as I went through the school years with them, I kept thinking, “What is this?” As time progressed and we saw that reading became more difficult for them, then I finally got into understanding that, yes, we’ve got to get them tested. And it went from that little, itty-bitty kind of a thing to understanding we’ve got something a lot bigger that we have to deal with here.

CW: When you say something “a lot bigger,” does that mean you were looking beyond the educational realm?

Maren: Well, at that point it starts in the educational realm because, as a parent, that’s really where it becomes magnified. But then all of the sudden it shifts to the social. And you find that many times these kids will like to play with kids younger than themselves, because again the social issues – they’re usually about two years behind socially. So as a parent you’re treating them emotionally as the age level that you see, but in reality you need to be treating them about two years behind. And a lot of families have a real problem with that, because they’ll say, “Gee, Johnny is ten years old and he’s acting like a baby. What’s the problem there?” And so we discipline them probably inappropriately. But if we understand what’s going on in the neurological sense, it makes sense. And as a parent, we can be a lot more patient with them.

CW: In your book, you encourage parents to “do more than cope” with learning differences. What do you mean by that?

Maren: I really think it’s important for parents to educate themselves. Remember, if you have a child with a learning difference, chances are you are an undiagnosed parent that has a learning difference. So as a parent, you need to cope by understanding and educating yourself how this child learns best and what kind of an educational environment do I need to seek out for them. And it’s not always what it seems. Many people think, “Oh, I’m going to do the public school route, that’ll be great.” But this child may crash and burn in that environment. So what’s going to be best for them? And many people go to the private school sector, and think, oh that’s great it’s going to be better because they’ll have smaller class sizes and they’ll pay more attention. But in reality those teachers have never been trained to actually teach a learning different child. So it basically magnifies their situation as a learning different student in a smaller setting. So they usually have a harder time. And homeschool is a really good option but it just depends on the parent, if they have the patience to do it.

CW: In that case, what is the number one piece of advice you would give to a parent who has learning differences?

Maren: If you notice and you’re thinking that you really have a problem, then the number one thing you need to do is get them tested. Make sure that it’s a good, educational diagnostician that’s doing it. So many people go to the public school system because it’s free. But the problem is with that is the public school only does the bare minimum. They are only trying to see how much money they’re going to get per kid for that next school year. It’s not a good thing. So what you want to do is make sure you go to a private, educational diagnostician and get the full-prong battery.

And once you know what you’re dealing with, then you can take care of it. But if you’re just guessing… So many families don’t want to test because they think their kid’s going to be labeled, but that once again is your parents’ pride. It’s like, “Oh my gosh, they’re going to tell us we’re dyslexic!” It’s gosh, what is this, a brand of the swastika? [laughing] Big deal, get over it. It’s so silly. And so you say, yes, he’s got a label. Big deal. You’ve got to get on with it. Figure out what you’ve got to do and it makes life a lot easier to live.

CW: Once your realize that you have a child with learning differences, what does that mean for the family? What does that mean for how the family’s lifestyle is going to change?

Maren: The big deal – and I’m guilty of this one – is once you realize that “Oh gosh, we have a problem in our family,” then everyone jumps on that problem and they forget about everyone else in the family. So a lot of times the siblings that don’t share that [learning difference] will think, “Well, what am I? Am I just dogmeat? Maybe I’ll have to be different or act out so I get the attention or I’ll just stay in the woodwork.” And then they internalize this and think, “Nobody likes me, nobody loves me.” And then as they grow up, that’s a whole other issue or problem that the family has to deal with.

So it’s really important when you get that diagnostic that you sit the whole family down and say, “This is what we’re dealing with, and your brother has this learning difference and this is how we have to communicate with him. And if you’re frustrated with him, then come to me and let’s talk about it and we’ll work it out as a family.” Rather than just, “Oh good, this child over here that’s non-learning different isn’t giving me any grief so thank God.”

CW: What advice can you give parents who have some kids with learning differences and some who don’t have learning difference?

Maren: You need to embrace it and realize that it was all a part of God’s plan. So many times when we get married, we have this romantic vision of what family life is going to be like. It’s going to be perfect, this, that and the other. And then things throw little loops in your life. So it’s all in the attitude and how you want to perceive it. Are you going to perceive it as horrible and evil – “Oh, we’re all going to die!” Or are you going to perceive that “Hey, we can turn this around and make it a positive.” You have to have a positive attitude about it…

Nick, our number three, could not tolerate medication so he had to figure out ways to calm himself down so that he could function. He really created his own set of behavior [modifications]. We laugh at him, because to calm him down at night, to go to bed, he just couldn’t calm down. And that’s really common with people with learning differences. They usually don’t go to bed until like three in the morning and then it’s really hard for them to wake up the next day.

And so I’d say, “Nick, isn’t it about that time? I’m so tired. I want to go to sleep.” “Mom, I just need to make the rounds.” And what he would do is go to everybody in the house, and talk with them, just “How you doing, what’re you doing.” And then he’d leave the room and go to the next person and the next person. And that’s how he calmed down. He would have to make three rounds to everyone’s room to kind of settle down. We’d all say, “Is this round one or two? I’m exhausted.” He’d say, “I just have to do it one more time. Just kind of go with it.” And so we’d all go with it.” It turned out to be a positive because he knew what was going on with everybody. And everybody just knew that that’s what he had to do. So we just embraced it.

CW: From the marriage perspective, how does parenting a family with such diverse learning styles affect the relationship between parents?

Maren: Well, you have to remember that either one or both of the spouses are possibly undiagnosed learning differences themselves. So they will have a lot of issues that they’re going to be bringing to the table. One being, do they really truly process what’s being said? A lot of times it looks like, “Hey, you’re not listening to me. Pay attention to me.” And a non-learning-different spouse, you don’t understand that they might have auditory processing [problems], you think, “Oh, he doesn’t love me” or “She’s not paying attention to me.” So if you [don’t] understand that that might be a problem, then that could be a really big issue.

Typically, the divorce rate among this population is huge because either spouse will go one of two ways. They’ll either say, “I’m out of here, I don’t want to deal with this,” or they’ll say, “Okay, they’ve got a learning difference and I’ll be patient and I’ll go the distance.” And that’s what you hope will be the case but it’s not always the case. So again, you have to communicate and you have to make sure that if you’re the non-learning different spouse, then you have to remember that less talk is more. So you can’t yack, yack yack, because the person can’t process what you’re saying. You have to just say what you mean and be very specific.

CW: Do you have any other practical suggestions for how parents can work together?

Maren: You’ve got to have half an hour a day with no TV and no kids. So that usually means at night after everybody’s gone to sleep. And by that time you’re probably so tired yourself. But you have to buck up and get together and just talk with each other and get that game plan for the next day. “How are we going to deal with such-and-such today and what are we going to do for the others?” And it could be something simple. Don’t make your goals so over the top that they’re not going to be achieved.

[F]or your learning-different kid, let’s say that you have [a goal to…] do homework time from five to six. And in that time, Mom’s going to take over and Dad’s going to make dinner. … Okay, that’s a really good thing we can do today. But what about the other kids that come in and start disrupting when I’m trying to deal with that child? Dad says, “No worries, I’ve got that covered.” If you’ve got that game plan before that drama starts, then that cuts down on all of the yelling and screaming, all of the misunderstanding that can happen in that scenario if you don’t make that game plan.

CW: One thing that you mention in the book is just how important routine can be for kids that get overstimulated easily. How does that affect family life?

Maren: Well, like you said, you’ve got to have that routine. For them, their brains are taking in everything with the same intensity that you would – I’m going to give you an example – if you go outside and you’re with your toddler or young child, and actually are looking at a kid playing soccer, and the learning-different child is with you.

You’re intently looking at kid playing soccer and that kid who has the learning difference is not only looking at the soccer player but he’s looking with the same intensity at the plane that’s going across the sky, the wind that’s going through the tree, another kid next to him that’s crying because his brother slugged him. And he’s not only observing with the same intensity; he’s hearing it in the same intensity. He can’t filter out all those other sounds. Everything’s the same decibel. You can imagine how loud that would be for them and how much stimulation. And they’re thinking that’s normal, because that’s all they know. And so what happens is typically the brain gets overloaded and then they melt down. They’ll pitch a fit and the moms will say, “Oh stop it, you’re fine.” Well, they’re not fine. They need to be in an environment that is the same pretty much every day. And it has to be low level of stimuli as far as noise. That’s a huge deal. And most parents, we don’t want that. We’re listening to the radio. We’re talking on the phone. We don’t want to be quiet. If we’re quiet that means that we’re boring. It’s true – how often do you really sit and be quiet?

CW: So that’s going to involve some sacrifices and changes on behalf of the parent. I guess that’s where attitude comes back in.

Maren: It is. And remember, isn’t that what God’s calling us to do, is to be quiet and be near his realm so we can understand where he wants us to be? And how do we not do that? And so that learning-different child is actually bringing a gift to you, but you’re saying, “Ah, I don’t think so. I got something better.” We have to catch ourselves all the time.

CW: Anything we haven’t covered that you think is important for parents to hear?

Maren: The next big thing that most parents are going to freak out on is the meds. Remember, on the medication, sometimes it’s a good tool. And you can put “tool” in capital letters. Most people think that’s the cure. “Okay, we’ll put him on meds and it’ll all be good.” Or they’ll freak out, thinking, “I’m not going to medicate my child! They’ll grow a horn or something!” And in fact, the dopamine levels or the serotonin levels are too low. That’s the way God made that individual. So what we have to do is boost those two chemicals in the brain, so that these neurotransmitters are actually working.

It’s kind of like when you put a plug in the wall. You know how when it’s kind of half out and it juices a little bit. I don’t know if you’ve ever been vaccuming and you take the vacuum into the other room and the plug’s still in the other room and it comes out of the wall a little bit. So when you’re vaccuming it goes off a little bit. It’s kind of the same with kids with learning differences. Their brains are not getting a full charge. The meds are just trying to give them that full charge.

The problem is when you take them to the pediatrician, he actually doesn’t have a real background in giving these meds. They typically are just giving what the drug reps give them. And the dosages are way out of whack for a child. That’s what gives the bad wrap socially on that. … What’s happening, if we get the right dosage, is then we’re actually just putting those neurotransmitters into the “go” mode so that the kids feel like they’re on an even playing field with everybody else. So that’s the good news. An remember, if parents are considering meds, have them go to a neuropsychiatrist that specializes only in ADD or a neurologist that specializes only in that population. Then you know that you’re going to get the right dosages. They won’t over-medicate or under-medicate. Because if the kid is doing well on meds, the kid will say, “I don’t feel any different. This is so silly. I don’t know why I’m on it.” And the people that are interacting with him will see the difference, like the teachers and parents.

First published on July 8, 2009

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Wednesday, July 22 2009
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Home > 2009 > August Christianity Today, August, 2009
We Need Health-Care Reform
And the real question is who gets to decide who gets attention.

I commend President Obama for forcing the issue of health-care reform into the public debate. Our present system, still the best in the world, needs to expand coverage to the uninsured. I've seen why.

The husband of a woman in my wife's Bible study lost his job and health insurance. Though in pain, he delayed seeing a doctor for months. Finally, his father loaned him money, and he had a large tumor removed from his colon. Had the tumor been discovered earlier, his prognosis might not have been so grim. Christians are helping this family, but there's little such hope for most of the 45 million uninsured Americans.

So, while it's clear we need health-care reform, it's not clear how to implement it, or who will decide who gets medical care. A May court case illustrates this problem. A mentally retarded Georgia teenager suffering from cerebral palsy had been receiving 94 hours of in-home nursing care from Medicaid per week, until the state decided to reduce it to 84. The patient's doctor protested. Her mother sued. Then, in Moore v. Medows, arguing before the 11th Circuit Court of Appeals, the government attorney argued that the state is the "final arbiter" of medical decisions. While the court tried to find middle ground, it affirmed the government's position, stating, "A private physician's word on medical necessity is not dispositive." 

This should be a warning sign for nationalizing health care: The government will make medical decisions, including, as we've seen in Canada and Britain, decisions of life and death. A British ophthalmologist who always had supported her country's National Health Service recently wrote about how a Zip Code lottery would decide the fate of her cancer-stricken father. She explained, "It is only now, sitting on the side of the patient, that I have seen the injustice inherent in our system."

While justice demands that health care be expanded, a one-size-fits-all government system isn't the answer. Medicare, of which I am a beneficiary, is a perfect example of why not. There is no incentive to save medical resources. Needless procedures are conducted; in one case in which I objected, I was told, "Why worry? The government pays!" In another case, I repeatedly wrote Medicare about a billing for a procedure that had been cancelled. I received only a form reply.

But whether our health-care system is governmental or private, full coverage necessitates greater resources. This will inevitably lead to rationing and thorny ethical questions. President Obama personally has wrestled with this. Soon after his grandmother had been given a few months to live because of a heart condition, she fell and broke her hip. The President questioned whether "society making those decisions to give my [terminally ill] grandmother a hip replacement . . . is a sustainable model."

But whoever decides who gets care, the real issue is by what standards those decisions will be made. This crucial question is being raised in a culture that largely has jettisoned the Judeo-Christian consensus for respecting the dignity of life and supplanted it with doing the greatest good for the greatest number. Peter Singer, a popular professor at Princeton, has been teaching this for years to packed classrooms, advocating that children with defects be killed in utero or after birth if they survive.He opposes medical care for Alzheimer's patients and the terminally ill. The only difference between the influential Singer and the mainstream public is that Singer makes us cringe by spelling out some consequences of utilitarianism that we would rather ignore.

Utilitarianism sounds good for the majority, but it puts society's weakest members at risk. I confess that at age 77, I have a personal stake in this. Not only am I vulnerable, but so is my beloved 18-year-old autistic grandson, Max, who in a utilitarian culture would no longer exist.

There's no pat answer, but the stakes couldn't be higher. That's why there has to be a public debate in which Christians participate and influence consensus. As we do, consider three guiding principles: human dignity, care for the poor, and prudence. 

Christians have to reassert that there are transcendent standards of right and wrong. While some kinds of heroic care may be withheld in hopeless cases, it is wrong to intentionally take a life. Second, we must champion care for the poor and the weak. Bringing health-care reform to the forefront is the first step. But prudence—a classical virtue that looks objectively at complex situations and applies moral truth—is the third concern. How do we best allocate limited resources?

There will not be a magic solution. But of all the initiatives being debated today, this one poses the greatest danger to the public welfare—which is why Christians must not sit on the sidelines.

Related Elsewhere:

Christianity Today follows political developments on the politics blog.

CT's health care coverage can be found in our science & health section, including:

Caring for the Caregivers | Studies suggest that pastors' health declines are a church problem. (April 14, 2009)
Blessed Insurance | Many pastors lack access to adequate health benefits. (July 7, 2008)
The Health Care Crunch | Let's make sure any reform plan we pursue avoids the single-value syndrome. (February 5, 2008)

Previous columns by Colson are available on our website.

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Tuesday, July 21 2009

Leadership Journal

Can Your Church Handle the Truth?
Recovery ministries demand a level of honesty many congregations aren't used to.
Matt Russell with Angie Ward

Monday, July 13, 2009

I am afraid that in many American churches, we are not telling the truth—at least not the whole truth.

In many churches we assume that once you accept Jesus as your Savior, you get involved in church and your life gets better. This is the standard story repeated in "testimony time" on Sundays, and the unspoken assumption regarding discipleship.

This "narrative of ascendency" has become the dominant American narrative of the gospel, rooted in American optimism and confidence. It is beautiful, compelling, and powerful. But is it the whole truth?

The church in America has struggled to embrace an equally true "narrative of descendency," the part of the gospel that is grounded in the One who descended into the depths of human darkness, and who calls us to face our particular and ongoing struggle with our own darkness.

We avoid this part of the story. We want a new life without a death. We want to ascend to Heaven before we descend into hell.

But the gospel includes both descendency and ascendency. The very process of recovery is understanding that there is a death, and there is a resurrection. They are inseparable, and it's a process that continues throughout our lives. The story of Mercy Street is a story of a community of faith in Christ that sees the gospel in both of those narratives.

My snowball interviews

Thirteen years ago, I had finished seminary and was trying to figure out what to do with my life. I called Jim Jackson, a friend who was the senior pastor at Chapelwood United Methodist Church in Houston, to ask him to help me think through some of the decisions I had to make. He asked me to work with him for a few years and get some ministry experience under my belt.

When I got to Chapelwood, Jim asked me, "What do you want to do?" I told him that I wanted to find a way to connect people who were outside the church, who saw no relevance in the way the church interacts with culture, with the gospel. Jim said, "Go for it. What do you need?"

I said I needed a laptop and a cell phone and told him I wouldn't be at the church a lot.

I asked Jim if he would give me the names of a couple of people who had left the church because they had bad experiences. Then I found a coffee shop in the Montrose area of Houston and cold-called the people on his list.

"My intention is not to invite you back to church," I said. "I want to hear what happened, how you felt, and what you wish was different. Will you just come and tell me your story?"

I didn't realize it at the time, but I ended up doing what is known as "snowball interviewing." After those first few interviews, I asked, "Is there anyone else you know who feels the same way about church? If I made the same promise to them, would you give me their name and number?" And they did. So for nine months, every day, Monday through Friday, I sat at Dietrich's Coffee Shop and interviewed people. I'd ask questions about their perceptions, their experiences, and their thoughts about church. What I heard broke my heart and changed my life.

Through these interviews, I came to see a distinct pattern. Most people left church not because they had a deep theological problem with something like the virgin birth or the resurrection of Christ. They left because people in church have the tendency to be small and mean and couldn't deal honestly with their own sin or the sin of others. As one man put it, "People in the church were more invested in the process of being right than in the process of being honest."

One of the main populations I interviewed was people who were in all types of recovery: from drugs, alcohol, sex addiction, eating disorders, gambling. Their interviews were full of stories of chronic behaviors that persisted despite confession, church attendance, small group participation, and Bible study. Many felt that their ministry leaders expected their behaviors to change as a result of prayer and participating in church activities. But that just wasn't the case.

As one person told me, "Just because you shellac a bunch of Jesus over your life doesn't make it right."

After nine months, I had conducted more than 70 interviews. I invited 30 of those people to a dinner to share with them what I had heard and learned.

A place that can handle the truth

During dinner I asked, "What if we became the answer to these problems? What if we formed a community that's honest, that welcomes those who feel disconnected and spiritually homeless?" These people responded that they wanted to be part of creating a church that would welcome those in recovery, where they could be vulnerable with each other as a way of growing spiritually.

In the past, these individuals had to step away from honest vulnerability in order to fit acceptability standards in the church. Some did it for a while, until they could no longer keep the masks in place and their addictive processes at bay. These people had been in the church for a long time but felt like they could never get honest when they talked with their pastor or small group leader. With Mercy Street, we wanted to change that paradigm.

Spirituality is social in nature. Dietrich Bonhoeffer said that Christ exists in community. The first problem that has to be overcome in Genesis is isolation, not sin. That has deep implications for how we preach the gospel. Our believing is conditioned at its source by our belonging. Spiritual growth is stunted without honesty in community. But our Christian language of victory can become so dominant that we no longer are being honest about our sinful impulses and behaviors.

We can hide behind spiritual language and discuss someone else's sin, so we don't have to confess our own.

In other words, we learned that addicts desperately needed a community of faith that could meet them at the same level of depth, authenticity, and vulnerability that they find in the Alcoholics Anonymous Twelve-Step program. They needed a church that was as committed to the narrative of descent as it was to the narrative of ascent.

At Mercy Street, we embrace the whole story. In one part of our service, we do "Celebrations," where people will stand up and celebrate being sober from drugs and alcohol for two days or twenty years; mothers will thank God that they are sober, have a job, and are getting their children back from Child Protective Services; men and women will celebrate getting off of parole, out of jail, or into a new job. It's both narratives all mixed in together.

Joining the Spirit's work in everyone

As I befriended recovering men and women, it became evident that many had experienced a spiritual awakening as a result of the stark honesty and transparency of the Twelve Steps. The same Spirit who had awakened them was now leading them to Jesus within the life of the church. When I would ask, "Where are you finding your spiritual nourishment today?" they would tell me, "I'm in this recovery group; I connect with God in those meetings."

Part of the way we see AA, Narcotics Anonymous, Gamblers Anonymous (or any of the "A" programs) is that we don't have to baptize them in the name of Jesus in order for them to be the work of Jesus. Christ exists incognito in the rooms of recovery. The Kingdom of God is coming in all places where people are being liberated from bondage, sometimes even in church buildings. Or AA. We want to participate where Jesus is in the world, redeeming people and calling them to himself.

At Mercy Street, Christ is central. There is no other name by which we can be saved.

But we also live by this adage: "Jesus may have saved your soul, but AA is going to save your ass; and your soul is no earthly good if your ass is not intact." If you step into Mercy Street and into recovery, you go to meetings, get a sponsor, and work the Twelve Steps. That's what you do. That is discipleship.

Churches are filled with people who have made a rational assent to Jesus as Savior but who resist the presence of the Spirit in their lives. They say, "I'm not forgiving her." Or "I'm not going to fight my pornography addiction, but I believe in Jesus, my personal Lord and Savior."

They want a spiritual experience without having to do the hard work of recovery and discipleship. But the hard work of facing the wreckage of the past and surrendering yourself to Christ in the mess is the very pathway of faith.

Cell groups and secure locations

At Mercy Street, we like to say that you're just as likely to sit next to someone from Penn State as from the State Pen. This is a reflection of some of our early experiences as a community.

Keith had been a crack addict for several years. He lived on the streets and in and out of halfway houses. By the time he showed up at Mercy Street, he was sober and in recovery, but he said, "When I was in treatment, I needed a place like this."

Keith noticed some vans in the parking lot that weren't being used and asked if he could pick up people from halfway houses. So he started picking up people every Saturday night from nine or ten houses in the area. A group of women petitioned the state of Texas to get out of lockout to be able to come to church for an hour on Saturday.

Another man relapsed and went to prison for three years. While he was there, a woman in our community wrote to him every week, sending him transcripts of our services: songs, announcements, sermons—everything. He wrote back: "Would you send four of these to me? The warden says we can only gather in groups of ten, but a lot of guys want to hear what's going on at church each week."

We now send transcripts to men and women incarcerated throughout the state of Texas. Each week they gather in orange and white jumpsuits to pray, encourage each other, read the transcripts, and "have church." Many of these men and women come to Mercy Street after serving their time.

"I've been coming to this church for months," one man told me, "but this is the first time I've ever been here!" We consider Mercy Street a multi-site church. It just so happens that many of our sites are maximum-security prisons.

A pastor in recovery

The church can be a great place for pastors to hide. We have a role, a title, a whole language, and a reputation that can insulate us, protect us, and conceal us. That's why one of the biggest blessings of this journey for me is that I have been able to face my own addictions.

Thirteen years ago, while interviewing Jake at Dietrich's, I began to cry. While the details of our stories were different, I saw similar patterns of struggling and hiding. I started to pour out my story to this man across the table. He let out an expletive and said, "I think I'm going to have to take you to a meeting."

Two days later I went to my first recovery meeting, having a degree in theology, having given my life to Christ at the age of 13, having led mission trips. But I don't think I'd ever really encountered Christ until that day in the coffee shop. I was 29 years old at the time, and I realized I had never been completely vulnerable about my ongoing struggles.

Jake became my sponsor.

In those meetings I learned how to say the darkest truth about myself in the light of day. Saying the words "My name is Matt, and I'm a recovering addict" continually reminds me that I have access to grace only through vulnerability and honesty. That was 13 years ago, and by the grace of God I continue to go to meetings, work the steps, and I am sober today.

I'm called to be a person, not just a pastor. That means I submit myself to the hard work of recovery. I'm like the guy in the hair-replacement ads: "I'm not only the founder, I'm also a member."

Some people that come to Mercy Street also attend some of the meetings I go to. In those meetings I stand firm in my identity as a recovering addict. I speak honestly, listen carefully, and work with my sponsor. These individuals know the details; they are the keepers of my secrets and the protectors of my anonymity.

When I preach, then, I am able to speak in much more general terms about the nature and character of the struggle that is germane to us all without shifting the responsibility of that struggle over to the wider community. I understand this to be what Paul meant when he said, "bear one another's burdens" (Gal. 6:2) but "carry your own load" first (Gal. 6:5).

Between 65 and 70 percent of the folks at Mercy Street say they are recovering from an identifiable process addiction or substance addiction and are going to weekly meetings. But we define addiction very broadly. A man came up to me one night and said, "I finally understand my addiction: I have an addiction to entitlement." That is to say that each of us struggles with an addiction. Addictions are things I put in front of God so that I don't have to deal with God, my pain, or other people. Jesus invites us to do the hard work of acknowledging it and maturing in him.

Without descending into the darkness of our own lives, there can be no ascendency. Thankfully, Mercy Street is living proof that God still raises people from the dead.

Matt Russellis founding pastor of Mercy Street in Houston, Texas, and is now pursuing a Ph.D. in adult identity development and recovery at Texas Tech.

Posted by: Reviewed by Dr. Dan L. Boen AT 10:32 pm   |  Permalink   |  Email
Monday, July 20 2009

From Medscape Medical News

Teen Drug Use Often Begins With the Family Medicine Cabinet

Janis Kelly

July 20, 2009 — Adolescents who buy prescription drugs for illicit use are more likely to have ongoing substance abuse problems, but most teen-drug misuse involves drugs obtained for free from family or friends. This is important because prescription-drug misuse by teens is rising even though the use of other illicit drugs, alcohol, and tobacco has decreased.

Prescription drugs are surpassed only by alcohol, tobacco, and marijuana in misuse by adolescents. A study by Ty Schepis, PhD, and Suchitra Krishnan-Sarin, PhD, published in the August 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, shows that much of this drug use likely begins at home.

The researchers also report that how an adolescent obtains prescription drugs predicts whether other substances, such as alcohol, are being abused at the same time and signals a risk for more severe substance and prescription-drug misuse problems.

Drs. Schepis and Krishnan-Sarin, both from the Department of Psychiatry at Yale University School of Medicine in New Haven, Connecticut, used data from the 2005 and 2006 National Survey on Drug Use and Health (NSDUH) to show that, across all classes of medications (opioids, stimulants, tranquilizers, and sedatives), nearly 50% were obtained from friends or family members free of charge.

With the exception of opioids, the most common source was purchasing the drug from friends or relatives (13.1% - 29.7%) or from a drug dealer (4.6% - 12.0%). For opioids, the second most common source was from a physician.

"The group with greatest odds of concurrent other substance use may be those who purchased their medication for misuse from friends, family, or drug dealers. In comparison with adolescents who misused medication obtained from a physician, adolescents who buy medication are more likely to have endorsed binge alcohol use (opioids and tranquilizers), daily cigarette use (opioids and stimulants), past month marijuana use (all 3 classes examined), and past year cocaine use (opioids and stimulants)," the authors conclude.

"Disturbingly Easy" to Obtain Drugs

Richard A. Friedman, MD, who also studies teenage drug abuse, told Medscape Psychiatry that "these data underscore how (disturbingly) easy it is for young people to obtain potentially abusable prescription drugs. It is clear from these data that the main source is not street dealers, but friends, family members, and physicians." Dr. Friedman is professor of clinical psychiatry and director of the Psychopharmacology Clinic at Cornell University's Weill Medical College in New York City.

Drs Schepis and Krishnan-Sarin say that their data indicate that physicians should be routinely screening all adolescent patients for prescription misuse.

"Screening for prescription misuse depends on your clinical impressions of your patient and of his/her current substance use. With patients who have a presenting complaint of depressive symptoms or anxiety, simply asking about substance use across the spectrum of alcohol, tobacco, marijuana, prescriptions, etc, in a nonjudgmental and matter-of-fact way is likely best," Dr. Schepis told Medscape Psychiatry.

"The main questions are about whether the patient has ever used a substance, timeframe of last use, and frequency of use over a specified time period. That information can then help a practitioner decide how to proceed with a potential intervention, if one is needed."

Urine testing may be indicated when a patient is in treatment for substance use or there is clear evidence that the patient has intentionally misled care providers about substance use. The risk inherent in urine testing, however, is that it can be very counterproductive for establishing and keeping trust, especially if it is a surprise to the patient," Dr. Schepis said.

False Impression?

Dr. Friedman suspects that because prescription drugs are approved by the US Food and Drug Administration and are widely advertised directly to consumers in the print and electronic media, young people might have the mistaken impression that these drugs are safe.

"After all, if their parents use them and their doctors prescribe them, how bad can they be? Another factor is peer acceptance. If you look at other data from this survey, acceptance of prescription drugs has been steadily rising, while attitudes among youth about cocaine and stimulants has become more negative," he said.

Dr. Schepis warned that availability is also a factor. "Many people have medications that they previously needed that remain in their medicine cabinet, perhaps an opioid analgesic for a surgery. These medications are easy targets for adolescents wishing to experiment, continue to use, or sell medications to peers. Thus, proper medication disposal is really important, and all patients should be counselled on that."

Major Implications

Dr. Friedman said that the implications of these findings for clinicians are "huge and pressing."

"Physicians have to be very careful about prescribing drugs of potential abuse to young people. Although it's true that the rates of undetected psychiatric illness are quite high in this population, the mainstays of [pharmacologic] treatment, are, with the exception of stimulants for attention-deficit/hyperactivity disorder, drugs like antidepressants, antipsychotics, and mood stabilizers — none of which are addictive. In contrast, there is rarely a medically legitimate rationale to use tranquilizers, hypnotics, narcotics, and the like in this usually medically healthy population," he said.

The study was supported in part by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2009;48:828-836.

Authors and Disclosures


Janis Kelly

Janis Kelly is a freelance writer for Medscape. She has been a medical journalist since 1976, with extensive work in rheumatology, immunology, neurology, sports medicine, AIDS and infectious diseases, oncology, and respiratory medicine.

Medscape Medical News © 2009 Medscape, LLC
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Posted by: Dr. Dan L Boen AT 05:28 pm   |  Permalink   |  Email
Sunday, July 19 2009
I took my two daughter and their kids to visit my office in Auburn. Although they had been to my office in Fort Wayne several times, for some reason they had never seen my Auburn office. On Friday we thought we would make a morning of it so off we went to drive north to Auburn to see what life was like in the smaller city, to visit some shops and to have lunch together. I love to get together with my kids and grandkids. I see the world through their eyes and see the things I so often miss with my own eyes. They slow me down as they wear me out and give me life in a different way.

As we entered the backdoor of my Auburn office, my little granddaughter, Anna, who is three went ahead with me and started to enter first. Just before she went in she stopped and looked up at me with her very serious intent expression and asked, "Is this where you fix broken hearts, Grandpa?" I was dumbfounded! Where did she get that? Then her mother reminded me, "Remember when she asked you what you did and you said you were a doctor but not the kind that gave shots? And then she asked you what kind of doctor you were? She is just repeating in her own words what she thought you said."

A doctor to fix broken hearts. I guess in a way that is what I am, at least in her eyes. I cannot think of a better description for what I do or rather hope to do.

Helping Hearts Heal,
Dr. Dan L Boen
Posted by: Dr. Dan L Boen AT 01:30 pm   |  Permalink   |  Email
Thursday, July 16 2009

What’s the difference between a crisis and an emergency?


Recently my son just had his first child and my sixth grandchild. In true fatherly fashion I decided it was time to impart some wisdom. Mark Twain said life can only be understood backwards but unfortunately it must be lived forwards. One of the principles of parenting that I developed and found priceless is to know the difference between a crisis and an emergency.


You see, to a child, everything is a crisis. As a baby they want food and want it now. As a teen they want what all the other teens want. As a young adult they want your money. To a child, everything is a crisis or a big deal. When you look at time through the eyes of a child it actually makes some sense. To a ten year old one year of their life is 1/10 of their existence. To their 30 or 40 year old mom and dad a year is only 1/30 or 1/40, quite a bit shorter in perspective. That is why in relationship a year, a week, or a day seems so long to a child and so short to their parents.


Since everything is a crisis to a child they want everything now or their world or happiness as they know it will cease to exist. As the parent we are responsible for their happiness in their mind and solving their crisis will allow them to be happy. No matter what it does to us.


As I sat with my son in the backyard and talked about his upcoming transition into the responsibility of fatherhood I shared with him this simple but powerful piece of advice: know the difference between a crisis and an emergency.


The difference? Blood. No blood, no emergency just a crisis. Blood=emergency, drop everything and get them to the hospital or doctor or clinic (assuming it is bad enough). Everything else is just a crisis. Don’t make their crisis your crisis. Give yourself time to think and pray. Manage the crisis as God works in your heart, mind, and life, unless there is blood.


If you ask my son today what is the difference between a crisis and an emergency he will say Blood!


Helping Hearts Heal,

Dr. Dan L. Boen

Posted by: Dan L. Boen, Ph.D., HSPP AT 01:46 pm   |  Permalink   |  Email
Sunday, July 05 2009
Why does it seem to take more time to get ready to take time off? Americans take less time off than any other developed country. We are working more hours and by every sign being compensated less during this down economy. I continue to hear story after story of companies and bosses taking advantage of the down economy and the lack of jobs to get more out of their employees without compensating them more. I cannot but wonder what will happen when the economy improves. Where will the loyalty be then? You reap what you sow. Companies cannot take advantage of employees now and expect them to stay when the economy improves and other opportunities present themselves.

Helping Hearts Heal,

Dr. Dan
Posted by: Dr. Dan L Boen AT 12:51 am   |  Permalink   |  0 Comments  |  Email
Friday, July 03 2009
Many adult children are returning home or not leaving to begin with. It used to be the thinking that when a child reached 18 they were legally and financially independent and should be on their own. Then society realized that 18 was too young so we should ensure children were ready and able to survive independently and most suggested waiting until young adulthood was reached at 21 or 22, college, military, or trade school was finished and the young adult could be on their own.

Now the thinking is emerging that 21 or 22 or maybe even 25 is too young to expect our children to survive on their own without needing assistance or support in an ever increasingly complex social and technical culture. What then should be the age parents should expect their children to be independent where parents can enjoy their children but not feel the need to be their financially or physically for the child's survival?

One way to think about this is to reason backward. If people are living longer, and they are, what is now middle age? When will people retire? Thirty used to seem old, but with the changes in aging the developmental stages are changing as well. Yes, 11 and 12 year olds are becoming physically more mature at younger ages, but the realization is gradually dawning all levels of society that our children are not ready for independence and maturity emotionally, socially, and financially until they reach their 30s. What a shock this is for both the child and the parents. Ninety per cent of adult children are ready to be independent by 30, but for many 30 is the age they need to reach to be independent.

Think of the profound changes this will create in the way we raise our children and their expectations on leaving home as well as the parent's expectations on when the child is ready and able. to leave.

Helping Hearts Heal,

Dr. Dan
Posted by: Dr. Dan L Boen AT 08:53 am   |  Permalink   |  0 Comments  |  Email
Wednesday, July 01 2009

There is a lot of information out there. "Out there" being defined as the web/internet. As I scroll through the content of the day that comes across my screen I realize much of what passes for information lacks wisdom and knowledge. In an attempt to be first or faster much of what is thrown out is either repetitive or not factual. Yes there is a lot of good sites and content, but the consumer also needs to be discriminating. It is easy to get "sucked into" a blog that passes for research or even research that passes itself as thorough and well done. Much of the information taken for gospel as it passes back and forth across the web has no solid foundation.

Perhaps it is good to slow done and reflect on what we read and not just read and repeat. Is it wise, is it valid, is it researched or is it opinion? Not that opinion is bad. That's what this is, but it needs to be identified as opinion and not passed off as fact.

Helping Hearts Heal,

Dr. Dan L. Boen

Posted by: Dr. Dan L Boen AT 01:34 pm   |  Permalink   |  0 Comments  |  Email
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