Doing the same thing over and over, and expecting a different result. I'm not sure who first defined insanity in those terms, but wow.  That shoe fits.

Mental health issues like depression and anxiety don't just fall out of the sky and hit us in the head one day.  They develop over time.  Usually, many factors are involved.  It's complicated.  When I'm trying to understand a client's story, the medical model helps me a lot.

The medical model says that mental health problems result from a combination of biological, psychological, and social factors.  A perfect storm of biological susceptibility, psychological stress, and social stress.

Biological susceptibility might include:  a family history of depression, anxiety, etc; an illness like thyroid disease; adrenaline stress or exhaustion; sleep deprivation.  Our brain is integrally connected to the rest of our body.  (That's what your neck is for, right?)  The things that impact our body will impact our brain, and that means they will impact our mood and mental health.

Psychological stressors tend to be things in the past:  trauma; stress; life transitions; an abuse history; family history of alcoholism, workaholism, ministryaholism, or whatever ism your family of origin happens to have.  I would include spiritual issues here.  All the lies and false beliefs that keep us stuck and despairing.

Social stress lives in the present:  marital discord; economic distress; problems in the workplace; conflict with family or friends.

All those things overlap and impact each other.  Think of those overlapping circles in a venn diagram.  (I was trying to put one on here but it didn't work so I'm going to rely on the power of your imagination for the graphics today.)

And here is where I think I often become the bearer of bad tidings.

If you want to get better, you will have to make change.

You might need to take medication.

You might need to take a good, hard look at things in the past that are painful.

You might need to make some tough changes in the present.

But here is what I know for sure.  If you keep doing the same thing over and over, expect the same results.  Expect the insanity to continue.  And realize that you're making that choice.

Maybe that sounds harsh, but I work with people who are really, really in trouble.  Kids who want to die.  Women in abusive relationships.  The problems are real.  And the solutions require courage and hard work and life-long change.

Anything less than that reality, is just somebody trying to sell you something.  And I think that the vendor is the Enemy of your soul.  So caveat emptor, everybody.

Here's an old story that's floated around for a while.  I found it printed in Encouragement, Barnabas International, July 1993.

Autobiography in Five Short Chapters

Portia Nelson

Chapter 1

I walk down the street.  There is a deep hole in the sidewalk.  I fall in.  I am lost and helpless.  It isn’t my fault but it takes forever to find a way out.

Chapter 2

I walk down the same street.  There is a deep hole in the sidewalk.  I pretend I don’t see it.  I fall in again.  I can’t believe I am in the same place, but it isn’t my fault.  It still takes a long time to get out.

Chapter 3

I walk down the same street.  There is a big hole in the sidewalk.  I see it is there.  I still fall in…it’s a habit.  My eyes are open and I know where I am.  It is my fault.  I get out immediately.

Chapter 4

I walk down the same street.  There is a deep hole in the sidewalk.  I walk around it.

Chapter 5

I walk down another street.

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